CAJ | 학술논문

目的：探讨医院DRGs试点的盈亏情况及其原因。方法调查北京某“三甲”医院2011年12月至2013年12月参与105组DRGs试点的9225例出院病历的盈亏情况。结果9225例病历中基本医疗保险占96.50%，居民保险3.50%；盈利DRGs组78组（74.29%），亏损DRGs组27组（占25.71%）；平均住院日9.37天，次均费用18032.27元，次均定额标准17337.53元，次均自费费用829.47元，次均自付二费用2448.57元，次均盈利2583.29元，次均自费自付二比例12.46%。盈利费用的对数与次均费用和平均住院日的对数呈负相关，与定额标准的对数和自费自付二比例呈正相关。结论当前DRGs试点模式医院整体盈利，对医院近期无显著影响。
목적：탐토의원DRGs시점적영우정황급기원인。방법조사북경모“삼갑”의원2011년12월지2013년12월삼여105조DRGs시점적9225례출원병력적영우정황。결과9225례병력중기본의료보험점96.50%，거민보험3.50%；영리DRGs조78조（74.29%），우손DRGs조27조（점25.71%）；평균주원일9.37천，차균비용18032.27원，차균정액표준17337.53원，차균자비비용829.47원，차균자부이비용2448.57원，차균영리2583.29원，차균자비자부이비례12.46%。영리비용적대수여차균비용화평균주원일적대수정부상관，여정액표준적대수화자비자부이비례정정상관。결론당전DRGs시점모식의원정체영리，대의원근기무현저영향。
Purpose To explore the profit and loss and the reasons of DRGs pilots of hospital.Methods The profit and loss of 9225 discharge cases participating in 105 groups of DRGs pilots of a third-grade class-A hospital in Beijing between December 2011 and December 2013 was investigated.Results Among 9225 cases, basic medical insurance accounted for 96.50%, and residents insurance accounted for 3.50%; 78 DRGs groups gained profit (74.29%), and 27 DRGs groups suffered loss (25.71%); the average day in hospital was 9.37, the average cost per time was 18,032.27 Yuan, the average quota standard per time was 17,337.53 Yuan, the average out-of-pocket cost per time was 829.47 Yuan, the average out-of-pocket cost 2 per time was 2,448.57 Yuan, the average profit per time was 2,583.29 Yuan, and the proportion of the average out-of-pocket cost 2 per time was 12.46%. The logarithm of profit cost was negatively correlated to the logarithm of the average cost per time and the average day in hospital, and positively correlated to the logarithm of quota standard and the ratio of out-of-pocket cost 2.Conclusion Using the current DRGs pilot model, the hospital gained profits, and it had no significant effect on the hospital in the near future.