DRG付费改革背景下慢加急性肝衰竭患者费用盈亏分析*

doi:10.3969/j.issn.1672-5069.2024.06.021

实用肝脏病杂志 ›› 2024, Vol. 27 ›› Issue (6): 882-886.doi: 10.3969/j.issn.1672-5069.2024.06.021

DRG付费改革背景下慢加急性肝衰竭患者费用盈亏分析^*

武羽, 韩宇星, 徐曼曼, 焦婧然, 杨雪, 段小宛, 陈煜

100069 北京市首都医科大学附属北京佑安医院肝病中心四科(武羽,徐曼曼,焦婧然,陈煜);肝病中心二科(杨雪);医保办(段小宛);肝衰竭与人工肝治疗研究北京市重点实验室(武羽,徐曼曼,焦婧然,陈煜);北京市首都医科大学第二临床医学院(韩宇星)

收稿日期:2024-06-12 出版日期:2024-11-10 发布日期:2024-11-07
通讯作者: 陈煜,E-mail: chybeyond1071@ccmu.edu.cn
作者简介:武羽,女,27岁,博士研究生,住院医师。主要从事慢加急性肝衰竭诊治研究。E-mail:112022010857@mail.ccmu.edu.cn;共同第一作者:韩宇星,22岁,医学学士。E-mail: 18911321610@163.com
基金资助:
^*北京肝胆相照公益基金会人工肝专项基金资助项目(编号:iGandanF-1082024-RGG068);北京市高层次公共卫生技术人才建设基金资助项目(编号:学科带头人-01-12);北京市医院管理中心“登峰”计划专项经费资助项目(编号:DFL20221501)

Hospital profit and deficit of medical costs in patients with acute-on-chronic liver failure based on DRG payment reform

Wu Yu, Han Yuxing, Xu Manman, et al

Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Diseases, You’an Hospital Affiliated to Capital Medical University, Beijing 100069, China

Received:2024-06-12 Online:2024-11-10 Published:2024-11-07

摘要/Abstract

摘要： 目的分析DRG付费改革背景下慢加急性肝衰竭(ACLF)患者住院费用与医院盈亏情况,为调整优化DRG支付标准提供参考依据。方法 2022年3月～2023年12月首都医科大学附属北京佑安医院住院治疗的ACLF患者,检索电子病案系统、费用数据库和医保数据库,计算年龄校正的Charlson合并症指数(aCCI)。结果在收治的北京市医保支付的ACLF患者377例中,经排除后纳入147例患者,男性120例,女性27例,年龄为56.0(43.5,64.0)岁,住院日为17.0(12.0,26.5)d,aCCI为5.0(4.0,6.0),住院费用为3.8(2.5,6.7)万元,日均费用为0.2 (0.2,0.3)万元,住院病死率为37.4%,住院费用医院亏损率为53.7%; 30%HS11组和49.1%HS15组亏损,平均亏损0.2万元;接受人工肝治疗患者被分为HJ1组,78.9%亏损,平均亏损金额为10.3万元; 90.9%HJ13组亏损,平均亏损3.5万元;HJ11组和HJ13组材料费占比分别为17.5%和21.0%,显著高于HS11组的3.8%或HS15组的3.0%(P<0.001);HS11组和HS15组盈余患者中位住院时间均为12.0 d,亏损患者则分别为28.0 d和18.5 d(P<0.001);HJ11组亏损患者较盈余患者年龄更轻,aCCI更低(P<0.05)。结论大部分DRG分组的ACLF患者医院都是亏损的,尤其是接受人工肝治疗者。建议将住院日纳入DRG分组元素,适当提高DRG分组支付标准,以保证重危肝病患者的救治。

关键词: 慢加急性肝衰竭, 疾病诊断相关分组, 住院费用, 盈亏结构, 人工肝治疗

Abstract: Objective The purpose of this study was to analyze hospitalization costs of patients with acute-on-chronic liver failure (ACLF) under background of diagnosis-related groups (DRG) payment system with aim of providing reference for optimization of DRG payment reform. Methods Patients with ACLF were encountered in Beijing You'an Hospital, Capital Medical University between March 2022 and December 2023, clinical materials were retrieved from HIS, cost data bank and medical insurance (MI) bank, and age-adjusted Charlson comorbidity index (aCCI) was calculated. Results 377 MI-paid patients with ACLF were encountered and 147 enrolled after exclusion, male 120, female 27, with median ages of 56.0(43.5, 64.0)yr, hospital stay of 17.0(12.0, 26.5)days, aCCI of 5.0(4.0, 6.0), medical costs of 38(25, 67) thousand yuan and 2 (2, 3) thousand yuan daily, hospital fatality of 37.4%, and medical deficit rate of 53.7%; medical deficits occurred in 30% HS11 group and 49.1% HS15 group, both with mean deficits of 2 thousand yuan; patients underwent artificial liver supporting system (ALSS) therapy were assigned to HJ1 group, and 78.9% of HJ11 group cost more medical burden than MI payment, with average deficit of 100.3 thousand yuan; deficit occurred in 90.9% of HJ13 group, with average deficit of 30.5 thousand yuan; medical material costs in HJ11 group and HJ13 group accounted for 17.5% and 21.0%, both much higher than 3.8% in HS11 group or 3.0%in HS15 group(P<0.001); median hospital stay in HS11 group and HS15 group with medical surplus were 12.0 days, while hospital stays were 28.0 days and 18.5 days in those with medical deficit P<0.001); patients in HJ11 group with medical deficit were much younger and the aCCI even lower than in those with medical surplus (P<0.05). Conclusion Under implementation of DRG payment reform, patients with ACLF in most DRG-assigned groups cost medical deficits, especially in those with ASLL therapy. We recommend the hospital stay should be enrolled for DRG cost, and appropriately increase payment criteria.

Key words: Acute-on-chronic liver failure, Diagnosis-related groups, Medical costs, Profit and deficit, Artificial liver supporting system

武羽, 韩宇星, 徐曼曼, 焦婧然, 杨雪, 段小宛, 陈煜. DRG付费改革背景下慢加急性肝衰竭患者费用盈亏分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 882-886.

Wu Yu, Han Yuxing, Xu Manman, et al. Hospital profit and deficit of medical costs in patients with acute-on-chronic liver failure based on DRG payment reform[J]. Journal of Practical Hepatology, 2024, 27(6): 882-886.

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DRG付费改革背景下慢加急性肝衰竭患者费用盈亏分析^*

Hospital profit and deficit of medical costs in patients with acute-on-chronic liver failure based on DRG payment reform

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