基于DRG同病同价思想的医共体分级诊疗实证研究OA

Objective To explore the impact of the DRG same-price-for-same-disease payment reform on hospital cost control and the path for promoting hierarchical medical treatment by analyzing the changes and trends in hospitalization expenses for the KS13 diabetes mellitus with general complications disease group in a county-lev-el medical community in Zhejiang Province after the implementation of the reform,involving a tertiary hospital(General Hospital A)and two primary hospitals(Branch Hospitals B and C).Methods Data of 1 635 inpatient medical records over a total of 35 consecutive months(from January 2022 to November 2024)were collected.T-tests,Kruskal-Wallis tests,and interrupted time series analysis were used to compare differences in the average cost per hospitalization and cost trends across hospitals before and after the policy implementation.Results There was no significant difference in the average cost per hospitalization before and after the policy implementation for General Hospital A and Branch Hospital B,while the average cost per hospitalization at Branch Hospital C de-creased from 4 430.72 RMB to 3 409.97 RMB,with the trend shifting from an increasing one to a decreasing one(P＜0.001).The average cost per hospitalization at General Hospital A was significantly higher than that at Branch Hospitals B and C(P＜0.001),and there was no significant difference between Branch Hospital B and C(P=1.000).Conclusions The DRG same-price-for-same-disease policy sets a cost benchmark for hospitals,and the cost control effect is more significant in primary hospitals.Higher-level hospitals need to optimize case mix,human resource allocation,and performance distribution based on the medical community framework to a-chieve overall cost optimization and benefit maximization of the medical community.