RÉSUMÉ
Objective:To analyze the adjustment of the amount of medical insurance reimbursement with the addition of the age factor, making the system more in line with the actual clinical resource consumption.Methods:Data were collected from the first page of medical records of 54 535 inpatients discharged from hospital between January 1 th, 2021 and December 31 th, 2021.First, the paired t-test was used to verify any statistical difference between the standard payment amounts before and after adjustment based on the model and the actual hospitalization expenses.Secondly, the actual cost was compared with the cost after the model-based adjustment and the current benchmark cost(before adjustment), respectively.The standard deviations of the two groups were compared to assess the difference between the benchmark cost and the actual cost before and after adjustment. Results:Through the Blom formula, the actual cost, adjusted benchmark cost and current benchmark cost data were normalized.After normalization, the actual expenses and the adjusted benchmark cost as well as the actual expenses and the current benchmark cost were compared, respectively, using the paired t-test, producing a P value of 0.97 for the former pair and a P value of 0.93 for the latter pair, both greater than 0.05, and the benchmark cost before and after adjustment could reflect the actual clinical resource consumption.However, the effect of benchmark cost adjustment was assessed by analyzing the standard deviation of the difference between paired values of the two groups.The standard deviation of paired values between the actual expense and the adjusted benchmark cost was 0.68, lower than the standard deviation of paired values between the actual expense and current benchmark cost, which was 0.7. Conclusions:With the inclusion of the age factor, the model can reasonably adjust the current benchmark cost based on the patient's age and verify that the adjusted benchmark cost can more accurately reflect the actual clinical resource consumption compared with the current standard.However, further improvement of the payment adjustment model is still needed.
RÉSUMÉ
Objective:To study the influence of patients' ages on average medical expenses under the diagnosis related group and prospective payment system(DRG-PPS)model.Methods:Medical records of 52 987 selected patients at a third-tier general hospital in Beijing were collected from January 1 to December 31, 2019, and were then divided into three age groups based on age, the elderly group, the middle-aged group and the young group, and one-way ANOVA was used to determine differences in medical expenses between the same DRG group and different age groups.Related-sample nonparametric tests and linear regression were carried out for the three age groups to estimate the influence of the age factor on the medical expenses of different DRG groups.Results:First, the data of the three age groups in the same DRG group were analyzed by one-way ANOVA.The P values of the DRG groups were less than 0.05, except for the cb39 crystal surgery DRG group; Then, the data of the three age groups in different DRG groups were analyzed with the nonparametric test( P=0.021, less than 0.05); Finally, linear regression analysis was also used to analyze the case data of the three age groups.The p value was less than 0.05, and the standardized influence coefficient was 0.173, suggesting age was positively correlated with hospitalization expenses. Conclusions:Age affects average hospitalization expenses.After the implementation of the DRG-PPS model, the payment of DRG patients should be standardized with the inclusion of the age factor.