DRG付费与医用耗材集中带量采购政策协同对脊柱融合手术病组的控费效果研究OA

Objective Taking the spinal fusion surgery group(IB 29)as a case study,this paper explores the synergistic impacts of Diagnosis-Related Groups(DRG)payment reform and centralized volume-based procurement of medical consumables on the average total inpatient medical costs,cost composition and patients'personal financial burden.It further evaluates their effects on curbing irrational medical cost growth,adjusting medical expense structure,and alleviating patients'economic burden,so as to provide evidence for relevant policy optimization.Methods Data on basic patient characteristics and medical expenditures were obtained of inpatients undergoing spinal fusion surgery(IB 29 group)from November 2021 to November 2023.Data were drawn from the hospital information system(HIS)and electronic medical record system of a tertiary hospital in Chongqing,as well as the DRG information system and settlement information system of the Healthcare Security Administration.The implementation of DRG payment reform in November 2022 and centralized volume-based procurement of orthopedic spinal consumables in June 2023 were defined as intervention time points.An interrupted time series(ITS)model was applied to analyze the trends in the average total hospitalization cost per case,the structure of hospitalization cost,and patients'financial burden before and after policy implementation.Results After the DRG reform,the average inpatient medical cost per case for IB 29 group decreased by 2.35%,showing a modest reduction.Following the implementation of the centralized volume-based procurement policy for orthopedic spinal medical consumables,the average inpatient medical cost per case dropped by 35.12%compared with the level before the DRG reform,representing a substantial decrease.After the implementation of centralized volume-based procurement for spinal consumables,the average medical consumables costs decreased by 19,686.78 CNY.The proportion of medical consumables costs fell to 46.99%,a decrease of 14.95 percentage points compared with the period before the DRG payment reform,while the proportion of medical service fees increased to 24.55%,an increase of 5.31 percentage points.ITS analysis showed that after the implementation of the consumables centralized volume-based procurement policy for orthopedic spinal consumables,both the average medical cost per case(β₂=-18,495.65,P＜0.05)and the average medical consumables cost per case(β₂=-18,256.66,P＜0.05)decreased significantly.In addition,after the implementation of centralized volume-based procurement for orthopedic spinal consumables,the copayment per patient decreased by 9,446.45 CNY,and the average out-of-pocket expenses decreased by 12,857.15 CNY.Conclusion The synergistic implementation of the DRG payment reform and centralized volume-based procurement of medical consumables effectively reduced the average hospitalization cost per case for patients in the IB 29 group,achieving the expected outcomes of optimizing the medical expenditure structure and reducing patients'financial burden.