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| Study on the treatment structure and burden of medical expenses of solid tumor diseases in tertiary public hospitals under diagnosis-intervention packe payment#br# |
| LIU Fangfang1 WANG Wenxin2 QU Jianwei3 XIAN Bensong4 DU Huifeng4 ZHOU Zhiqiang5 |
1.Department of Oncology, Chifeng Municipal Hospital, Inner Mongolia Autonomous Region, Chifeng 024000, China;
2.Vice Dean Office, Chifeng Municipal Hospital, Inner Mongolia Autonomous Region, Chifeng 024000, China;
3.Medical Insurance Management Office, Chifeng Municipal Hospital, Inner Mongolia Autonomous Region, Chifeng 024000, China;
4.School of Health Management, Inner Mongolia Medical University, Inner Mongolia Autonomous Region, Hohhot 010110, China;
5.Depar- tment of Scientific Research, Affiliated Hospital of Chifeng College, Inner Mongolia Autonomous Region, Chifeng 024000, China
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Abstract Objective To provide a reference basis for optimizing the disease structure, controlling medical expenses, and promoting the balance of medical insurance under diagnosis-intervention packe (DIP) payment by analyzing the treatment structure and burden of medical expenses of solid tumor diseases in tertiary hospitals. Methods Three tertiary medical institutions (Chifeng Municipal Hospital, Affiliated Hospital of Chifeng University, Chifeng Tumor Hospital) were sampled from Chifeng City of Inner Mongolia Autonomous Region by using typical sampling as sample hospitals. The DIP payment data, medical insurance reimbursement data, and medical expense data of solid tumor patients hospitalized by each sample hospital from November 2021 to April 2022 were collected. According to the RW and sub-average medical expenses indicators, it was divided into four categories: dominant disease, potential disease, basic disease, and inferior disease. Disease admission structure and medical expenses burden were analyzed. Results A total of 13 946 solid tumor patients were collected. Three hundred and eighty-seven DIP solid tumor diseases were entered according to the main diagnosis and surgical operation data. Among them, there were 142 dominant diseases, 43 potential diseases, 109 basic diseases, and 93 inferior diseases. The dominant disease of hospital had a surplus of 14.01 yuan per 100 yuan of medical expenses. Potential disease had a loss of 13.28 yuan per 100 yuan of medical expenses. Basic disease had a surplus of 7.96 yuan per 100 yuan of medical expenses. Inferior disease had a loss of 7.91 yuan per 100 yuan of medical expenses. Conclusion Under DIP payment, tertiary medical institutions should be guided by DIP disease data, implement precise policies, and optimize the admission structure of disease types in depth. Based on DIP disease types, carry out refined medical cost control work, reduce the burden of patients’ medical expenses, and maintain the balance of hospital medical insurance revenue and expenditure, so as to promote the reform of medical insurance payment methods and achieve a win-win situation for medicine, insurance and patients.
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