On October 22, from the international experience, as a result of the DRG packaging pay relies on the adjustment of disease group score, the more big hospitals, were the more complex cases, the disease group and the higher score, and small hospitals, on the other hand.
For those who usually relies mostly on spin patients hospitalized time and through the use of inspection and prescribe medicines more profit small hospital, the impact of the DRG will be larger.
As the pilot DRG open, taken effect will gradually appear in the hospital.
Chinese private hospital's technical level is low, has long been at the low level of competition, with a low level hospital as the core, the pressure on the future will be more and more big.
DRG to civilian battalion hospital will mainly concentrated in five aspects: the influence of service efficiency, cost, transfer, transfer cases, results and income structure.
First of all, from the point of service efficiency, the civilian battalion hospital actual efficiency is not high in China.
The first, and the hospitalization time is not.
In 2017, the Chinese hospital, the average hospitalization time about 9.
3 days, more than 10, 2010.
5 days decreased by 1.
The average hospitalization time 9 public hospital.
4 days, lower than in 2010, 1.
Civilian battalion hospital is 8.
7 days, more than 2010 increased by 0.
3 days, especially after 2015, the private hospital time increased obviously.
Due to civilian battalion hospital is 74% level hospitals, public hospitals are two tertiary hospitals, 75% so private hospitals on the degree of critically ill patients were hospitalized with overall is significantly lower than in public hospitals, but civilian battalion hospital hospitalization duration is close to public hospitals and in the environment in hospital time shorter cases continues to rise, visible in hospital service efficiency is not economic.
Second, but the length of time is long, low cost of cases indicating that private hospitals not complex cases, more by stretching in the hospital for a profit.
All hospitals in 2017 per capita hospitalization expenses for 8890.
7 yuan, from 2010 to 2017, average annual growth of 5%;
Public hospital for 9563 yuan, with an average annual growth of 6%.
Which can be concluded that civilian battalion hospital inpatient cost lower than that of public hospitals, and average annual growth rate lower than that of public hospitals.
At present domestic level of hospital are about 74% of the private hospitals, low cost, the requirement is low, hospitalization means lower pay, if the DRG, will face a low cost, and shorter hospitalization time challenge, for the overall operation pressure is very big.
Secondly, from the point of charge transfer, DRG will promote hospital inspection and some drugs to hospital before and after school.
Because cases of civilian battalion hospital is not complicated, can transfer projects are relatively limited, in the face of the hospitalized duration compression under the premise of, it is difficult to compensate itself is compressed by shift to outpatient income.
Is also facing the same problem in the field of medical consumables, less complicated cases, patients can be induced by the use of high value consumables are also less, big hospital patients can be induced to use at high value consumables to profit, mainly small hospital of civilian battalion hospital cannot do a certain volume of charge transfer.
Again, from the point of transfer cases, induction and decomposition of hospitalization will be significantly suppressed.
This admissions per one hundred people in eastern is the lowest, only 2.
Nine people, in the western region and central regions are all six people.
The inhabitants of the eastern region in hospitalization rates of 12.
9%, while the western and central regions of 14 respectively.
1% and 16.
Visible higher percentage in the hospital in central and western region, there are some improper hospitalization, frequent hospital situation, if the DRG helps make more fine management, for a high proportion of the central and western regions to use hospital hospital, will face in the hospital is limited by a bigger challenge.
Improper while the situation of the hospital has, all over the country but more apparent in the central and western regions, in private hospitals in these areas is affected by the DRG will be greater.
From a cost point of view of each disease categories all disease categories from 2013 to 2017, the average per capita hospitalization cost average annual growth of 4%, average hospitalization costs 8711 yuan in 2017.
The hospitalization expenses of the fastest growing disease categories is pregnancy, childbirth and the puerperium disease, average annual growth rate of 7%, followed by injury and poisoning;
And originated in the disease in the perinatal period, with an average annual growth of 6%, in addition, there are three kinds of disease categories of average annual growth of 5%, tumor, mental and behavior disorders, and digestive system diseases.
Thus it can be seen as a whole disease cost growth is obvious.
After the execution of DRG DRG declare points from the international changes, disease complex degree and resource consumption rising cost relatively high disease categories more obvious, while the opposite with reduced cost.
Now from the Chinese market, pregnancy and childbirth classes cost growth is most obvious, whereas the categories is not the highest degree in severe disease categories.
So for the hospital, the implementation of the DRG will the cost of all kinds of diseases have more strict control effect, severe degree is low, the consumption of resources less disease categories will be under a lot of cost down a challenge.
Finally, from the point of hospital income structure, low level hospital inpatient service technology, rely on subsidies is serious, if you can't guarantee the number of patients, and better control costs, once in DRG paying, will face great challenges, from another dimension, so is a county-level hospitals.
While hospitals have quite a lot of high risk high pay case, but there are also some cases could face losses, so the DRG implementation for hospitals at all levels, all force the hospital will consider the treatment cost, in the past, only look at revenue efficiency will be broken, the hospital must consider what category may produce benefits, and what the unnecessary costs will lead to loss of the group.