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中医优势病种按DIP付费的住院费用关联分析

Correlation Analysis of Hospitalization Expenses Paid by DIP for Dominant Diseases of Traditional Chinese Medicine

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【摘要】 目的:通过DIP支付方式下中医优势病种住院费用的关联分析,为进一步推动中医优势病种支付方式改革提供参考。方法:利用Apriori算法对中医优势病种住院患者相关数据进行关联挖掘。结果:多项指标与实际分值费用、结余和参保人负担三者的关联关系较强。病种分类、化验费、检查费、药费、总费用与实际分值费用的关联关系较强;病种分类、参保人费用负担、化验费、检查费、药费、总费用与结余的关联关系较强;病人(医保)类型、化验费、药费与参保人负担的关联关系较强。结论:DIP付费与中医优势病种结合良好,符合医、保、患三方利益,但也存在不同医保类型的患者获得感差距较大的问题。

【Abstract】 Objective: This paper discusses the correlation analysis of the hospitalization expenses of TCM dominant diseases under the DIP payment mode, and provides a reference for further promoting the reform of the payment mode of TCM dominant diseases. Methods: The Apriori algorithm is used to conduct association mining on the data of inpatients with TCM dominant diseases. Results: Many indicators are strongly related to the actual score cost, balance and burden of the insured. The correlation between disease classification, laboratory fees,examination fees, drug fees, total costs and actual score costs is strong. There is a strong correlation between disease classification, burden of the insured, laboratory fee, examination fee, drug fee, total cost and balance. There is a strong correlation between the medical insurance type of patient, laboratory fees, drug costs and the burden of the insured. Conclusion: The combination of DIP payment and TCM dominant diseases is good, which is in line with the interests of the hospital, medical insurance and patients, however, there is also a large gap in patients’ satisfaction with different types of medical insurance.

【基金】 广东省哲学社会科学规划项目2022年度常规项目(GD22CYJ27)
  • 【文献出处】 中国医疗保险 ,China Health Insurance , 编辑部邮箱 ,2023年04期
  • 【分类号】R197.3
  • 【下载频次】75
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