Impact of DRG payment method reform on refined management of close knit county medical community medical insurance
ZHOU Lifang
XU Zhanyu
TU Yuanxing
JIN Liping
Abstract：Objective To explore the impact of diagnosis related groups(DRG)payment method reform on refined management of close knit county medical community medical insurance,and to provide a reference for achieving reasonable cost control and efficiency improvement.Methods Eleven medical and health institutions in Lanxi City of Zhejiang Province were selected as the research objects to evaluate their performance and medical insurance management quality before and after the implementation of DRG.Results After the implementation of DRG,the case-mix index(CMI)increased significantly from 0.813 to 0.929,with a statistically significant difference(P＜0.05).The nosocomial infection rate decreased significantly from 1.42％to 0.28％,with a statistically significant difference(P＜0.05).The average hospitalization cost and length of stay per patient were 7 115.87 yuan and 6.86 days,respectively,showing a significant decrease compared with 7 569.85 yuan and 7.85 days before the implementation,with statistically significant differences(P＜0.05).Indicators such as the clinical pathway management rate and medical insurance policies awareness of employees also improved significantly compared with those before the implementation(P＜0.05).Conclusion The refined management of medical insurance in close knit county medical community based on the reform of the DRG payment can enhance management efficiency,standardize medical behavior,reduce the burden on the public for healthcare,and improve patient satisfaction.
Keywords：diagnosis related groupsrefined managementclose knit county medical communitymedical insurance
Publication Date：2024-12-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 842-845 )