Discussion on diagnosis-related payment for bilateral surgery: taking varicose veins of lower limbs as an example / 中华医院管理杂志

ABSTRACT

Objective:To analyze the cost difference between bilateral surgery and unilateral surgery in the same diagnosis-related group(DRG), and to explore the necessity of coefficient adjustment in DRG payment for bilateral surgery.Methods:The medical record frontpage information of all discharged patients who were divided into FJ25(complicated operation of venous system, without complications and accompanying diseases)by DRG in a tertiary hospital from 2017 to 2019 was selected, and the cost difference between unilateral operation and bilateral operation was compared.Results:A total of 359 patients were included, including 230 patients(64.07%) in unilateral operation group and 129 patients(35.93%) in bilateral operation group. There was no significant difference in gender, age and length of hospital stay between unilateral operation group and bilateral operation group( P>0.05). The hospitalization expenses of the bilateral operation group were higher than those of the unilateral operation group( P<0.05), and the differences mainly came from the expenses of consumables, operation, anesthesia and drugs. There was no significant difference in the expenses of diagnosis and treatment, and the cost of inspection between the two groups( P>0.05). The individual burden of patients with medical insurance in bilateral operation group was higher than that in unilateral operation group. Conclusions:In the same DRG group, the adjustment coefficient can be used to adjust the medical insurance payment for bilateral surgery, so as to avoid the occurrence of clinical decomposition hospitalization behavior.