DRG视阈下中医医院绩效管理的挑战与优化策略OA

Objective Based on the context of medical insurance payment reform,this study systematically evaluates the impact mechanism of two phased performance management models implemented in a tertiary traditional Chinese medicine hospital on medical service capacity,efficiency,and medical insurance supervision.It aims to provide references for optimizing perform-ance management strategies in traditional Chinese medicine hospitals.Methods A total of 131,079 patients were divided into three groups according to the time points of the two rounds of reforms.Interrupted time series analysis was used to analyze the trends in medical service capacity,efficiency,and medical insurance supervision before and after the reforms,and non-paramet-ric tests were applied to examine differences in the structure of hospitalization costs.Results Target Performance Management Phase:Medical service capacity showed no significant improvement(average monthly increase in CMI:0.004,P＞0.05);med-ical service efficiency improved only marginally(CMI-standardized average hospital stay decreased by 0.002 days/month,aver-age cost per case decreased by 40.39 yuan/month,while the proportion of consumables and medical service fees increased by 0.24％/month and 0.12％/month,respectively,P＞0.05 for all);medical insurance losses worsened(average surplus per case decreased by 19.05 yuan/month,P＜0.01).Combined Management Phase:Medical service capacity was suppressed(average monthly decrease in CMI:0.01,P＜0.001);medical service efficiency significantly improved(CMI-standardized average hospi-tal stay,average cost per case,and proportion of consumables decreased by 0.06 days/month,165.22 yuan/month,and 0.07％/month,respectively,while the proportion of medical service fees increased by 0.42％/month,P＜0.05 for all);medi-cal insurance turned from loss to profit(average surplus per case increased from-170.67 yuan to 142.82 yuan,though the growth trend was not significant).Conclusion The two rounds of performance management models have phased differences in their im-pact on medical service capacity,efficiency,and medical insurance balance.Dynamic and phased adjustments to performance management strategies are required.