摘要
目的:分析低倍率病例特征,探究低倍率病例形成原因,提出规范医疗行为、优化支付政策的建议。方法:以M市为研究场域,获取159 065例低倍率病例信息,采用特征价格模型,分析低倍率病例的基本特征以及对医疗费用的影响。结果:疾病特征、费用特征、个体特征、分布特征、行为特征均对低倍率病例的医疗费用产生显著正向影响;低标准入院、不规范医疗行为、诊断和编码升级、分组与支付缺陷是低倍率病例的主要形成原因。结论:为减少不合理低倍率病例,应优化监管规则、完善考核机制、强化院内质控、完善分组与支付机制。
Objective To analyze the characteristics of low-ratio cases,explore the reasons for the formation of low-ratio cases,and to put forward suggestions for standardizing medical behavior and optimizing payment policies.Methods Taking M city as the research field,the information on 159 065 low-ratio cases were obtained.Using the characteristic price model,the basic characteristics of low-ratio cases and their impact on medical costs were analyzed.Results Disease characteristics,cost characteristics,individual characteristics,distributional characteristics,and behavioral characteristics all had a significant positive impact on the medical costs of low-ratio cases.Substandard admissions,unstandardized medical behavior,diagnostic and coding upgrades,and grouping and payment deficiencies were the main reasons for the formation of low-ratio cases.Conclusion In order to reduce unreasonable low-ratio cases,it is necessary to optimize regulatory rules,improve assessment mechanisms,strengthen internal control within the hospital,and improve grouping and payment mechanisms.
作者
潘雪冬
彭美华
钟艳红
杨松
顾强
李希
李悦
肖远会
PAN Xuedong;PENG Meihua;ZHONG Yanhong;YANG Song;GU Qiang;LI Xi;LI Yue;XIAO Yuanhui(The Third Affiliated Hospital of Chengdu Medical College,Pidu District People's Hospital,Chengdu Sichuan 611730,China;不详)
基金
四川省纪检监察课题“医保基金监管‘行纪衔接’困境与对策研究”(SCJ220202)。
关键词
低倍率病例
医疗行为
特征价格模型
low-ratio cases
medical behavior
characteristic price model
