Research On DRG Cost-Benefit Analysis Based On Cost-Volume-Profit Model

BackgroundIn recent years,the reform of medical insurance payment methods has been steadily advancing with the continuous improvement of China’s public hospital reform program.On the one hand,China’s medical insurance payment methods have gradually changed from the single payment mode based on medical service items to multiple composite payment modes such as lump-sum advance payment,disease diagnosis payment and per capita payment;on the other hand,the reform of medical insurance payment methods has a direct effect on hospitals,guiding medical institutions to change the current extensive and scale expansion operation mechanism,and to turn to more content-oriented development and more internal cost control.Among them,cost-benefit analysis is the basis of coordinated promotion of hospital medical insurance payment reform,which is of great significance for realizing high-quality development of hospitals.With the background of DRG as the means of medical insurance payment accelerating promotion,DRG cost-benefit analysis is an inevitable requirement to perfect hospital operation and management system and promote high-quality development of hospitals.ObjectiveTaking a certain public hospital in Shandong Province as an example,based on the theoretical basis such as the payment method and DRG,the cost of DRG groups was calculated according to the cost-income ratio method,and then the breakeven model was used to analyze the cost of DRG groups,determine the number of cases required to reach the breakeven point,the total cost of the breakeven point and the payment standard of the breakeven point,judge the actual profit and loss situation of the DRG group,and analyze the influencing factors and existing problems of the loss-making group,so as to provide scientific basis for the refined cost management of DRG.MethodsLiterature research method:retrieve Chinese and English literature related to "Disease Diagnosis Related Groups/DRG" and "CVP Analysis",use CiteSpace for literature visualization analysis,provide theoretical basis for the theme of this research.Field study method:collect basic information such as medical record homepage data,hospital financial cost data and DRG grouping data from sample hospitals from January to August 2022 through field survey.Using Excel and SAS 9.0 analysis software,cost accounting,cost-benefit analysis and multiple linear regression analysis of 30 surgical DRG groups with the main diagnostic category MDCI were conducted.Cost accounting was applied with cost-income ratio method,cost-benefit analysis was applied with the CVP model,and the test level of multiple linear regression model was α=0.05.ResultsThe application of cost-income ratio method calculation of the group cost results showed that the total cost in the group mainly included the costs of ward units,anaesthesia units,drug units and consumables units.The results of CVP analysis and profit and loss analysis showed that in the group of RW≤3,except for group IB35(RW=2.64),the other groups did not reach the breakeven point,which belonged to the loss group;in the group of 3<RW≤5,except for the employees of groups IC23,IC25,IB31 and IB33,the others did not reach the breakeven point,which belonged to the loss group;the group of RW>5 did not reach the breakeven point,which belonged to the loss group.According to the multiple linear regression analysis,the loss of group IF55(orthopedic fixation removal/correction without complications and comorbidities,RW=0.74)was mainly affected by the cost of non-surgical treatment and antibiotics,the IC33 group(joint surgeries of hip,shoulder,knee,elbow and ankle with general complications and comorbidities,RW=1.91)had the greatest impact on the occurrence of losses mainly due to the cost of clinical diagnosis items;and the IB23 group(spinal fusion surgery with general complications and comorbidities,RW=5.37)had the highest degree of resource consumption,and its losses were mainly affected by rehabilitation costs.This study selected DRG groups according to the degree of resource consumption and the degree of complications and comorbidities,which verified the two research hypotheses proposed:(1)the lower the RW value,the more likely the third-grade hospital would be at a loss;(2)the lighter the degree of complications and comorbidities,the more likely the third-grade hospital would be at a loss.Conclusion and SuggestionThis paper constructs a CVP analysis model based on the cost-income ratio,and selects some DRG groups based on RW segment to verify it,which shows the extension value of the cost-income ratio to calculate the cost of DRG groups.It verifies the scientificalness of judging the DRG groups’ profit and loss situation based on the cost,and demonstrates the feasibility of applying CVP analysis model to analyze the cost-benefit of DRG groups in public hospitals.It also draws the conclusion that the key control for the DRG’s break-even operation should be the cost unit of drugs and consumables,and verifies the research hypothesis that the smaller the RW number or the lighter the degree of complications and comorbidities,the more likely it is for the tertiary hospitals to be in deficit.Based on the above conclusions,this study suggests that:promote tertiary hospitals to transfer patients with low and moderate difficulty to primary and secondary hospitals,which is not only beneficial to control their own costs,but also to guide patients to achieve reasonable referral and form a good hierarchical diagnosis and treatment pattern.It is recommended to adjust the internal cost structure of the middle and high-difficulty disease groups,reduce the cost of drugs and consumables,and assist clinical pharmacists in the cost control of drugs.The hospital should sort out the use of medical consumables in the hospital,focusing on the large amount of use or rapid growth of medical consumables;It is suggested that medical insurance institutions should establish a dynamic adjustment mechanism for payment standard of DRG disease group based on cost accounting results.