Journal of Practical Hepatology ›› 2024, Vol. 27 ›› Issue (6): 882-886.doi: 10.3969/j.issn.1672-5069.2024.06.021

• Liver failure • Previous Articles     Next Articles

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   

  1. 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

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