Effects Of DRGs Medical Payment Method Of A New Rural Cooperative Medical Treatment System On The Length Of Hospital Stay,Re-admissions,and Reimbursement Compensation Ratios In A Region Of Liaoning

Objective: To carry out a descriptive study of cardio-cerebrovascular diseases based on the payment method of diagnosis-related groupings,and to explore the differences between the two types of medical payment methods,such as length of hospital stay,re-admission,and reimbursement compensation ratio.Methods: Select 2013-2018 new rural cooperative medical insurance information management database in a certain region of Liaoning Province was selected,and all cardiovascular and cerebrovascular diseases were screened and classified according to the Beijing clinical version of the ICD-10v6.01 disease code.Organize basic information of patients with cardiovascular and cerebrovascular diseases and hospitalization cost information.Compare the differences in length of stay,re-admissions,and reimbursement compensation ratios for cardiovascular and cerebrovascular diseases under different payment methods;understand the situation of hospitalization expenses and reimbursement expenses.Results: There are 15,546 patients(6891 males and 8655 females)for non-DRGs payment methods,of which the proportion of female patients is 55.67%.There are17,040 patients(7774 males and 9266 females)for DRGs payment method,of which the proportion of female patients is 54.38%.In non-DRGs payment methods,the average age of the patients is 67.91 ± 11.40 years.In the DRGs payment method,the average age of the patients was 66.69 ± 11.12 years old.After the introduction of DRGs payment method,the number of hospital stays of participating patients decreased and was statistically significant(P <0.001);the number of hospital stays of patients with cardiovascular and cerebrovascular diseases decreased,which was statistically significant(P <0.05);Heart disease,cerebral infarction,pulmonary heart disease,heart failure,insufficient blood supply to the vertebrobasilar artery,dilated cardiomyopathy,other cardiovascular diseases,and other cerebrovascular diseases.The number of hospitalization days after the introduction of DRGs medical payment methods was statistically significant(P <0.05).After the introduction of DRGs payment method,the readmission rate of participating patients increased and was statistically significant(P<0.001);the readmission rate of cardiovascular disease and cerebrovascular disease increased,which was statistically significant(P <0.05)In addition to dilated cardiomyopathy,the readmission rate of patients with various cardiovascular and cerebrovascular diseases increased;of which,the readmission rate of coronary heart disease,cerebral infarction,and heart failure was statistically significant(P <0.05);The multivariate analysis showed that age and medical payment grouping may be risk factors for re-admission to cardiovascular and cerebrovascular diseases.Among them,compared with non-DRGs payment methods,the risk of re-admission to DRGs payment methods(OR = 1.188,95% CI = 1.060,1.330;P = 0.002).After the DRGs payment method was introduced,the reimbursement compensation ratio for participating patients increased and was not statistically significant(P = 0.062);the reimbursement compensation ratio for cardiovascular disease increased,and the reimbursement compensation ratio for cerebrovascular disease decreased,and both have Statistical significance(P <0.05);the reimbursement compensation ratio of patients with coronary heart disease,arrhythmia,and other cerebrovascular diseases increased,and the reimbursement compensation ratio of patients with cerebral infarction,cerebral hemorrhage,and dilated cardiomyopathy decreased,which was statistically significant(P <0.05).Conclusions:1.After the county-level hospitals in a certain region of Liaoning Province enforced the payment method based on disease diagnosis,the number of hospital stays for patients with cardiovascular and cerebrovascular diseases was shortened,and the readmission rate increased.2.After the county-level hospitals in a certain region of Liaoning Province enforced the implementation of the payment method based on disease diagnosis,the hospitalization expenses,reimbursement expenses,and reimbursement compensation ratios for cardiovascular and cerebrovascular diseases did not change significantly.3.At present,it is not clear what the impact of the mandatory group-based payment method for disease diagnosis on the financial burden of patients with cardiovascular and cerebrovascular diseases is.The health care reform covers a wide range,and research needs more evidence to evaluate DRGs payment methods for medical treatment.The impact of health care efficiency needs further in-depth research to determine.