CAJ | 학술논문

目的探讨医院DRGs试点的收支情况及其原因.方法调查北京某三级甲等医院2011年12月至2013年12月参与105组DRGs试点的9 225例出院病例的支收情况.结果 9 225例病例中基本医疗保险占96.54％、居民保险3.46％;结余DRGs组78组(74.29％),亏损DRGs组27组(25.71％);平均住院日9.37天,次均费用18 032.27元,次均定额标准17 337.53元,次均自费费用829.47元,次均自付二费用2 448.57元,次均结余2 583.29元,次均自费自付二比例12.46％.结论当前DRGs试点模式医院整体结余,对医院近期无显著影响.
목적 탐토의원DRGs시점적수지정황급기원인.방법 조사북경모삼급갑등의원2011년12월지2013년12월삼여105조DRGs시점적9 225례출원병례적지수정황.결과 9 225례병례중기본의료보험점96.54％、거민보험3.46％;결여DRGs조78조(74.29％),우손DRGs조27조(25.71％);평균주원일9.37천,차균비용18 032.27원,차균정액표준17 337.53원,차균자비비용829.47원,차균자부이비용2 448.57원,차균결여2 583.29원,차균자비자부이비례12.46％.결론 당전DRGs시점모식의원정체결여,대의원근기무현저영향.
Objective To investigate the profit-loss of the hospital's DRGs pilot and its reasons.Methods An investigation of the profit-loss situation of 9 225 cases of a hospital in Beijing,who have been discharged from December 2011 to December 2013 and grouped into 105 DRG pilot groups.Results As shown in the medical records of 9 225 cases,96.54％ are covered by urban employee basic medical insurance,and 3.46％ by urban residents' medical insurance; 78 DRGs groups were recorded as with profit(74.29 ％),while 27 recorded as with a loss(25.71％) ;average length of stay as 9.37 days,average expense per hospitalization per person as 18 032.27 yuan,average quota standard as 17 337.53 yuan,average out-of-pocket cost as 829.47 yuan,average second charge as 2 448.57 yuan,average profit as 2 583.29 yuan,average sum of out-of-pocket payment ratio and second charge ratio as 12.46％.Conclusion The current DRGs pilot model shows the hospital as profit making in general,with no significant impact on the hospital.