Research on Optimization Strategies for Orthopedic Implant Management Based on DIP Medical Insurance Payment

WANG Wei; LIANG Haohui

doi:10.16458/j.cnki.1007-0893.2025.18.002

Abstract：Objective To explore the influence mechanism and optimization path of orthopedic material management under the background of the superposition of artificial joint centralized procurement policy and diagnosis-related group(DRG)/disease diagnosis-related group(DIP)medical insurance payment reform.Methods Based on the data of 732 orthopedic surgery cases in a tertiary general hospital in Shenzhen from January 2022 to September 2024,variance analysis was used to compare six indicators including average cost per case and material cost ratio for the two main diagnoses of"femoral neck fracture"and"avascular necrosis of the femoral head"under DRG/DIP payment methods.Results The average cost per case decreased by 30.93%(P<0.001)due to artificial joint centralized procurement,but it rebounded by 6.54%(P<0.001)after DIP payment,and the material cost ratio rebounded from 51.69%to 55.39%.The pre-set surplus amount changed from a surplus of 30,400 yuan during the DRG payment period to a loss of 600 yuan during the DIP payment period.The material cost ratio decreased after the implementation of centralized procurement for both diagnoses,but the material cost ratio for"femoral neck fracture"rebounded by 30.61%(P<0.05)after DIP payment.The laboratory test cost ratio for"femoral neck fracture"showed significant differences under the influence of artificial joint centralized procurement and medical insurance payment policy adjustments(P<0.05).The examination cost ratio and laboratory test cost ratio for"avascular necrosis of the femoral head"showed significant changes due to the centralized procurement policy(P<0.05).The material cost ratio and pre-set surplus amount for both"femoral neck fracture"and"avascular necrosis of the femoral head"were strongly positively correlated(r=0.62 and 0.68,respectively),while the drug cost ratio was strongly negatively correlated with the pre-set surplus amount(r=-0.55 and-0.72,respectively).Conclusion DIP weakens the cost control effect of centralized procurement of orthopedic materials through the redistribution of disease scores.It is suggested to establish a three-dimensional evaluation model of disease type-orthopedic materials-therapeutic effect,implement hierarchical authorization management of orthopedic materials,and construct a dual assessment system including economic and quality indicators to improve the efficiency of medical insurance fund utilization through a"evaluation-assessment-optimization"closed loop.