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论文编号：	15410
作者编号：	2320200481
上传时间：	2025/6/10 18:04:42
中文题目：	基于DRG的公立医院成本管理优化研究 —以S医院为例
英文题目：	Research on optimization of cost management in public hospitals based on DRG--Taking S Hospital as an example
指导老师：	刘志远
中文关键字：	DRG支付；公立医院；成本管理；病例组合指数；质量成本协同
英文关键字：	DRG payment; Public hospitals; Cost management; Case Mix Index (CMI); Quality-Cost synergy
中文摘要：	随着我国医保支付方式改革的深化，DRG支付制度的全面推行对公立医院成本管理模式提出了全新挑战。疾病诊断相关分组（Diagnosis Related Groups, DRG）是一种以病例组合为核心的医疗支付与管理工具，其核心是将临床过程相似、资源消耗相近的病例归入同一分组，并基于分组标准进行费用支付，即实际成本超出支付部分，医院需要自负盈亏。如何适应DRG支付要求，实现成本控制与医疗质量的协同发展，成为公立医院亟待解决的核心问题。 本研究以山东省某三甲公立医院（S医院）为研究对象，系统探讨DRG支付背景下公立医院成本管理的优化路径。通过深入分析发现，医院现行成本管理模式存在成本核算粗放、预算动态响应不足、临床路径执行偏差及考核激励失衡等问题，导致资源错配与医疗质量风险并存。例如，传统成本核算方法难以精准反映病组真实资源消耗，间接成本分摊方式引发病组成本失真；预算编制僵化无法适应病例结构动态变化，高权重病例的资源需求难以保障；绩效考核过度侧重经济指标，诱发临床收治行为异化，影响医疗质量。 针对上述问题，本研究提出系统性优化策略：在成本核算层面，构建差异化科室分类核算模型，剥离非诊疗成本以提升核算精度；在预算管理层面，设计智能动态调整机制，实现资源分配与病例复杂度的动态适配；在过程控制层面，分科室制定精准控费路径，通过技术迭代与流程优化降低冗余成本；在考核激励层面，重构质量成本协同评价体系，将患者功能恢复、并发症控制等质量指标纳入考核维度，平衡经济效率与医疗价值目标。 研究结果表明，优化策略的实施可显著提升医院成本管理效能。本研究为公立医院适应DRG支付改革提供了理论框架与实践参考，对医院优化成本管理与推动医疗服务质量提升具有现实意义。
英文摘要：	With the deepening reform of medical insurance payment methods in China, the comprehensive implementation of the Diagnosis Related Groups (DRG) payment system poses new challenges to the cost management models of public hospitals. DRG, a case-mix-based payment and management tool, categorizes clinically similar cases with comparable resource consumption into homogeneous groups, with payments determined by predefined standards. Under this system, hospitals bear financial risks for costs exceeding DRG payment thresholds. Balancing cost control with healthcare quality under DRG constraints has become a critical challenge for public hospitals. This study investigates optimization pathways for cost management in public hospitals under the DRG payment framework, focusing on a tertiary public hospital in Shandong Province (Hospital S). Through comprehensive analysis, the research identifies systemic deficiencies in the hospital’s current cost management practices, including crude cost accounting methods, insufficient budget flexibility, deviations in clinical pathway implementation, and misaligned performance incentives. For instance, traditional cost accounting fails to accurately capture resource utilization per DRG group, while arbitrary allocation of indirect costs distorts cost attribution. Rigid budgeting cannot adapt to dynamic shifts in case complexity, leading to resource shortages for high-weight cases. Overemphasis on financial metrics in performance evaluation further incentivizes distorted clinical admission behaviors, jeopardizing care quality. To address these issues, this study proposes a systematic optimization strategy: (1) Cost accounting refinement: Establishing a differentiated departmental classification accounting model and excluding non-clinical costs to enhance precision; (2) Dynamic budgeting: Designing an intelligent adjustment mechanism to align resource allocation with real-time case-mix index (CMI) fluctuations; (3) Process control: Developing department-specific cost containment pathways through technological innovation and workflow optimization; (4) Incentive realignment: Reconstructing a quality-cost synergy evaluation system that integrates patient functional recovery, complication rates, and other quality indicators to harmonize economic efficiency and clinical value. Empirical results demonstrate that these strategies significantly improve cost management efficacy. The study provides a theoretical framework and practical insights for public hospitals to adapt to DRG payment reforms, offering actionable solutions to optimize resource allocation while advancing healthcare quality.
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