DRG支付背景下口腔专科医院住院服务及费用现状分析——以武汉大学口腔医院为例

Analysis of the current status of inpatient services and costs in a stomatological specialty hospital under the DRG payment——a case study of Hospital of Stomatology Wuhan University

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摘要 [目的]了解口腔专科医院住院服务及医疗费用现状,分别从医疗服务能力、医疗费用管理能力2个维度分析口腔专科医院所有住院DRG组的情况,从医院总体运营层面划分口腔专科医院的优劣组,并提出管理意见。[方法]调取2023年1月1日-12月31日医保住院患者的病案首页信息、费用结构信息,在指标中选取可以代表医疗服务能力及费用管理能力的指标,运用熵权TOPSIS法及波士顿矩阵方法计算各病组的得分及分布情况。[结果]熵权TOPSIS结果显示,从医疗服务能力评价上看,DG29(C_(i)=0.80)、DA19(C_(i)=0.46)、DG19(C_(i)=0.35)的医疗服务能力较好;从费用管理能力评价上看,DZ13(C_(i)=0.84)、JV1A(C_(i)=0.83)、BY19(C_(i)=0.82)、DR11(C_(i)=0.82)、QR13(C_(i)=0.82)组的医疗费用管理能力较好。波士顿矩阵结果显示,口腔专科医院住院服务运营的主要问题集中在瘦狗组及问题组。[结论]相较于综合医院,口腔专科医院的住院学科划分更细,但是DRG的分组未能充分体现,导致医疗服务能力较好的组费用控制能力较差。同时由于缺乏对其他学科疾病的收治能力,导致专科医院存在较多因禁忌症未行手术而出院的患者,即波士顿矩阵分析中发现瘦狗组与问题组出现较多的原因。 Objective This study understands the current status of inpatient services and medical costs in a stomatological specialty hospital,and analyzes all inpatient DRG groups in a stomatological specialty hospital from two dimensions:healthcare service capabilities and medical cost management capabilities.Superior and inferior groups of the stomatological specialty hospital are identified from the overall operation level,and management recommendations are proposed.Methods Data of the front page of medical records and cost structure of inpatients with medical insurance from January 1,2023 to December 31,2023 were collected.Indicators reflecting healthcare service capabilities and cost management capabilities were selected.The Entropy-weighted TOPSIS method and Boston Matrix were applied to calculate scores and distribution patterns of DRG groups.Results The results of entropy-weighted TOPSIS analysis revealed that from the evaluation of medical service capabilities,DG29(C_(i)=0.80),DA19(C_(i)=0.46),and DG19(C_(i)=0.35)demonstrated superior healthcare service capacities.From the evaluation of cost management capabilities,DZ13(C_(i)=0.84),JV1A(C_(i)=0.83),BY19(C_(i)=0.82),DR11(C_(i)=0.82),and QR13(C_(i)=0.82)had better medical cost management capabilities.The results of Boston Matrix indicated that the main problems of the inpatient services and operation of the stomatological specialty hospital were concentrated in the prevalence of“dog”and“question mark”categories.Conclusions Compared with general hospitals,the inpatient departments in the stomatological specialty hospital are more finely divided.However,the DRG grouping fails to adequately reflect these distinctions,resulting in weaker cost control in groups with better medical service capabilities.Furthermore,the limited capacity to treat diseases from other specialties leads to a higher proportion of patients discharged without undergoing surgery due to contraindications,which explains the prevalence of“dog”and“question mark”categories identified in the Boston Matrix analysis.