Affiliations: [a] Department of Oncology, Zhuozhou City’s Hospital, Zhuozhou, Hebei, China | [b] Zhongguancun Venture Capital Development Co., Ltd, Beijing, China | [c] Quality Control Office, Zhuozhou City’s Hospital, Zhuozhou, Hebei, China
Note: [1] Yanhua Zhang and Libao Teng contributed equally to this work.
Abstract: BACKGROUND: In order to prevent the occurrence of high-cost cases, it is necessary to know the proportion of high-rate cases and the hospitalization cost of patients. OBJECTIVE: Through the analysis of the high-rate cases of various specialties in a first-class hospital in a province, the profit and loss situation of medical institutions under the diagnosis-intervention packets (DIP) payment reform was discussed to seek a more effective way of medical insurance payment reform. METHODS: Data of 1955 inpatients who participated in DIP settlement in January 2022 were retrospectively selected. The Pareto chart was used to analyze the distribution trend of high-cost cases and the composition of hospitalization expenses in each specialty. RESULTS: The high-cost cases are the main reason for the loss of medical institutions at the time of DIP settlement. Neurology, respiratory medicine and other specialties are the focus of high-cost cases. CONCLUSION: The cost composition of inpatients with high-cost cases is in urgent need of optimization and adjustment. DIP payment method can control the use of medical insurance funds more effectively, which is the guarantee for the refined management of medical institutions.
