Analysis of the impact of China Healthcare Security Diagnosis-Related Groups payment reform on the treatment behavior of Uvulopalatopharyngoplasty for obstructive sleep apnea patients in Hospital C
Abstract Objective Given that the trial operation of CHS-DRG reform, the study aimed to explore how hospitals can manage diseases with strong technological reputation but suffer losses in DRG payments. Methods Taking UPPP for OSA patients in Hospital C as an example, the study analyzed whether there were changes in cost reduction, cost structure, patient disease severity, and medical quality before and after payment reform. Results Hospital C did not experience phenomena such as referral of difficult patients (CCI index, AHI index, and lowest SPO2 did not significantly decrease), staged surgery (hospitalization was not decomposed for patients requiring two surgeries for combined nasal diseases), increased costs for out-of-town medical insurance patients (out-of-town medical insurance patients significantly decreased), and reduced medical quality (recent efficacy and long-term benefits did not significantly change) during the reform. However, there were behaviors such as transferring preoperative examinations to outpatient clinics and controlling high-value medicine consumption. Conclusions By adjusting clinical pathways and transferring costs to outpatient clinics, Hospital C actively responded to the losses of UPPP patients and achieved the expected goal of quality control, cost reduction, and efficiency improvement. However, under the pressure of actual losses, hospitals should establish a mechanism of hospital-physician-patient win-win situation, strengthen refined management within the hospital, and improve the financial data performance within the hospital. The medical security department should also actively explore DRG accurate payment and even value-based payment, to help hospitals achieve high-quality development rather than become a constraint..
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Preprint| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
ResearchSquare.com - (2023) vom: 10. Okt. Zur Gesamtaufnahme - year:2023 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
Yang, Jing [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| doi: |
10.21203/rs.3.rs-3410344/v1 |
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| 520 | |a Abstract Objective Given that the trial operation of CHS-DRG reform, the study aimed to explore how hospitals can manage diseases with strong technological reputation but suffer losses in DRG payments. Methods Taking UPPP for OSA patients in Hospital C as an example, the study analyzed whether there were changes in cost reduction, cost structure, patient disease severity, and medical quality before and after payment reform. Results Hospital C did not experience phenomena such as referral of difficult patients (CCI index, AHI index, and lowest SPO2 did not significantly decrease), staged surgery (hospitalization was not decomposed for patients requiring two surgeries for combined nasal diseases), increased costs for out-of-town medical insurance patients (out-of-town medical insurance patients significantly decreased), and reduced medical quality (recent efficacy and long-term benefits did not significantly change) during the reform. However, there were behaviors such as transferring preoperative examinations to outpatient clinics and controlling high-value medicine consumption. Conclusions By adjusting clinical pathways and transferring costs to outpatient clinics, Hospital C actively responded to the losses of UPPP patients and achieved the expected goal of quality control, cost reduction, and efficiency improvement. However, under the pressure of actual losses, hospitals should establish a mechanism of hospital-physician-patient win-win situation, strengthen refined management within the hospital, and improve the financial data performance within the hospital. The medical security department should also actively explore DRG accurate payment and even value-based payment, to help hospitals achieve high-quality development rather than become a constraint. | ||
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