Babić Uroš, Soldatović Ivan, Vuković Dejana, Milićević Milena Šantrić, Stjepanović Mihailo, Kojić Dejan, Argirović Aleksandar, Vukotić Vinka
Vojnosanit Pregl. 2015 Mar;72(3):251-7. doi: 10.2298/vsp131108078b.
BACKGROUND/AIM: Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR) is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology.
The data were obtained from the information system used in the Clinical Hospital Center "Dr. Dragiša Mišović"--Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012.
Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p < 0.001) respectively. The univariate analysis showed that the highest correlation with the current payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p < 0.001, and ρ = 0.637, p < 0.001, respectively). Multivariate regression models confirmed the influence of the number of hospitalization days to costs under the current payment system (β = 0.843, p < 0.001) as well as under the projected DRG payment system (β = 0.737, p < 0.001). The same predictor was crucial for the difference in the current payment method and the pro- jected DRG payment methods (β = 0.501, p < 0.001).
Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs) per DRG. Given that aggregate costs of treatment under two hospital payment methods compared in the study are not significantly different, the focus on minor surgeries both under the current hospital payment method and under the introduced DRG system would be far more cost-effective for a hospital as great variations in treatment performance (reductions of days of hospitalization and complications), and consequently invoiced amounts would be reduced.
背景/目的：按日历年计算的全球预算是塞尔维亚为医院提供资金的传统方式。诊断相关分组（DGR）是一种医院付费方式，它基于将患者分类到临床问题相似且医院资源利用相似的组中。本研究的目的是比较泌尿外科当前的医院服务付费方式与按诊断相关分组付费方式预测的成本。
数据来自塞尔维亚贝尔格莱德“德拉吉沙·米绍维奇博士”临床中心——德丁耶使用的信息系统。已实施的医院信息系统是选择医疗机构的主要标准。该研究纳入了2012年随机选取的994例接受手术和保守治疗的患者。
当前付费方式下的平均成本略高于诊断相关分组预测的成本，然而，成本变异性是后者的两倍（分别为54,111±69,789和53,434±32,509，p<0.001）。单因素分析表明，与当前付费方式以及诊断相关分组预测付费方式相关性最高的是住院天数（分别为ρ = 0.842，p<0.001和ρ = 0.637，p<0.001）。多因素回归模型证实了住院天数对当前付费系统下成本的影响（β = 0.843，p<0.001）以及对预测的诊断相关分组付费系统下成本的影响（β = 0.737，p<0.001）。相同的预测因素对于当前付费方式与预测的诊断相关分组付费方式之间的差异至关重要（β = 0.501，p<0.001）。
诊断相关分组系统下的付费在管理上更为复杂，因为它需要对诊断和手术进行详细且标准化的编码，以及每个诊断相关分组的资源平均消耗（成本）信息。鉴于本研究中比较的两种医院付费方式下的总体治疗成本没有显著差异，对于医院而言，无论是在当前医院付费方式下还是在引入的诊断相关分组系统下，关注小型手术都将更具成本效益，因为治疗效果（住院天数和并发症的减少）会有很大差异，从而开票金额也会降低。
