基于DRGs的住院分娩单病种费用标准研究

目的 基于疾病诊断相关分组研究住院分娩费用标准，为医保按病种付费改革提供参考依据。方法 数据来源于2013—2016年60 954例住院分娩病例病案首页，利用非参数检验和多重线性回归分析住院分娩费用影响因素，通过CHAID决策树模型进行病例组合分组，计算标准费用和费用上限。结果 分娩方式、妊娠合并症与并发症、是否伴随其他妇科手术3个因素作为分组变量，形成12个住院分娩费用DRGs，标准费用对实际费用的解释比例达93.70%。结论 科学合理选择分组变量，构建更加符合实际的病例组合和费用标准，有助于推动医保按病种付费方式的完善与发展。

Study on the Standard of Inpatient Delivery Cost Based on Diagnosis Related Groups

Objective To provide reference for medical insurance DRGs reform,study on the standard of hospital delivery expenses was conducted.Methods A total number of 60 954 cases of hospital delivery cases from 2013 to 2016 was used and analyzed with nonparametric test to determine the influencing factors.The CHAID decision tree model was used to group the cases.Standard costs and expenses limit were calculated.Results Mode of delivery, complications and comorbidities, and other gynecological surgery were selected as grouping variable, eventually forming 12 hospital delivery costs DRG groups.93.70% of the actual costs can be reasonably explained by the standard costs.Conclusion Scientific and rational choice of grouping variables, a more realistic combination of cases and cost standards, help to promote the development of medical insurance payment reform.