Study On Hospitalization Expenses Based On The Principle Of Diagnosis Related Group(DRG)

BackgroundSince the new medical reform China's national medical insurance system has been continuously improved,and the coverage of medical insurance has been continuously expanded,so that the basic medical insurance coverage rate is more than 95%.At the same time,with the progress of Imedical technology and the improvement of living standards,people also put forward higher requirements and more demands for medical services,which leads to the increasing pressure of medical insurance fund payment,the rising medical costs,and the problem of expensive medical treatment.In order to change these situations,China has gradually explored the reform of payment methods.Research on home and abroad shows that DRG payment has become the general trend.Its essence is to group cases and compensate the cost of the case group by the established limit.The profit of the hospital is determined by the difference between the cost standard of the diagnosis related group and the inpatient cost.If the treatment cost of the patient exceeds the standard of the diagnosis related group,the hospital will lose money.The payment principle puts forward new requirements for the hospital to ensure the priority of efficiency,improve the ability of cost control,and control the medical resource consumption of patients in the disease group within the cost standard.Therefore,in order to actively adapt to the DRG payment mode reform,S Hospital of traditional C hinese medicine expects to determine the standard reference value of case group expenses based on the DRG grouping concept,control the medical resource consumption of patients from the links of hospitalization process,so as to reduce unnecessary hospitalization expenses and hospitalization time,control medical expenses and cost,improve the medical efficiency and standardize the medical behavior.ObjectiveBased on the grouping principle of DRG and the treatment process expenses,the study made the case grouping and determined the reference value of each group's expense standard and the patients who exceed the expense standard,which are convenient to find out the problems about specific links and treatment programme of hospitalization.Then,the improvement measures are proposed to promote the sample hospital to improve the medical efficiency and cost control ability,standardize the medical behavior and process,reduce the burden of patients' disease,so as to more smoothly implement the DRG payment reform.MethodsIn this study,qualitative and quantitative methods were used to collect and analyze data.In the qualitative analysis,6 professionals,who had rich work experience,were interviewed to understand the principle of disease grouping,clarify the division of patient treatment process,and discuss the results of data analysis,which aimed to analyze the specific reasons for the excessive cost of the patient and propose improvement measures.In the quantitative analysis,firstly,the basic situation of the research object was described;then,the influencing factors of hospitalization expenses were analyzed by single factor(t-test or non-parametric test)and multiple linear regression in order to determine the case grouping variables;and the variation coefficient,reduction of variance and Kruskal-Wallis test were to evaluate the rationality of case grouping results.Finally,the groups were divided according to the determined reference value of case group cost standard.Then,two independent sample T test and Mann-Whitney U test are used to compare the hospitalization expenses between the patients whose expense above and below the case group cost standard.Results(1)By using the method of single factor and multiple regression analysis,the study found the complication status and length of stay(LOS)are the influencing factors of patients' medical expenses consumption.And combined expert consultation with quantitative analysis,the patients formed 4 case groups which were taken hospitalization expense as the grouping core and the complication status as the grouping variable.The results of evaluation(CV<1,RIV=0.2784,Kruskal-Wallis Test P<0.001)showed that the grouping effect was ideal.What's more,the expense criteria and upper limit of each group's cost were also established.(2)According to the expense criteria,the patients of each case group were divided into the out-of-standard group and in-standard group.Through the analysis of the hospitalization costs of the patients in the out-of-bid group among the 4 case groups,it was found that the cost of western medicine,testing and disposable materials accounted for a relatively high rate.Compared with the in-standard group,the difference of the testing costs between the two groups wasn't statistical significance(P>0.05).In addition,the difference between the cost of each item category in the out-of-standard group and the in-standard group was the largest difference in Western medicine costs,which were 42.77%,31.77%,28.30%,and 38.14%,respectively.The remaining cost differences which accounted for a large proportion were check fees,bed fees and treatment fees.And the differences of bed fees and teatment fees in the two groups were with statistical significance(P<0.05).Therefore,the main categories that affected the patients' hospitalization cost exceeding the standard were the cost of western medicine,disposable materials,bed and treatment.(3)Through the analysis of the ratio of difference of hospitalization expense in the different process links between the out-of-standard group and the in-standard group,it was found that the top three links were hospitalization examination,operation and postoperative recovery but the operation link was lower than the in-standard group in the case group 3.Furthermore,the contrastive analysis between two groups in the 4 case groups,it came out that hospitalization examination link and postoperative recovery link were the main process links which incurred excessive expenses.Conclusions and suggestionsBased on the grouping principle of DRG,the study analyzed the case group and the hospitalization expense which exceeded cost standard of the case group,the main conclusions are as followed:firstly,the choice of classification variables in the case group is relatively single,which needs to be further improved and optimized;secondly,the structure of hospitalization expenses is unreasonable,the cost of Western medicine is on the high side;thirdly,the process of hospitalization treatment is not optimized enough,and the length of stay is too long;fourthly,the nonstandard treatment or charging behavior leads to the increase of link cost.Therefore,based on this study,the following suggestions are put forward(1)Standardize and perfect the homepage of medical records,improve the quality of medical records management(2)Standardize the use of drugs in the perioperative period and reduce the proportion of Western medicine cost.(3)Give full play to the advantages of traditional Chinese medicine and promote the coordinated development of traditional Chinese and Western Medicine.(4)Optimize the process of inpatient treatment and shorten length of stay.(5)Strengthen the management of clinical pathways and standardize the behavior of treatment.