Faculty of Public Health and Tropical Medicine, 123285Jazan University, Jazan, Saudi Arabia.
Faculty of Medicine and Health Sciences, 54706UNIMAS, Kota Samarahan, Malaysia.
Inquiry. 2021 Jan-Dec;58:469580211056060. doi: 10.1177/00469580211056060.
Health care systems aim to deliver high-quality medical care while considering efficient resource usage and cost-effective forms of interventions. Such purposes require scientific tools or mechanisms which aid in cost assessment before the efforts of cost reduction are considered. Diagnosis-related groups based costing methodology (Case-mix) is considered one of the preferred costing approaches in the health care sector. King Fahd Central hospital Jazan, the only tertiary hospital in the Jazan region, was selected for case-mix system-based patient-level costing of health services. The study's objective was to estimate the cost per Diagnosis-Related Group (DRG) per inpatient admission and compare it with the already established average cost of health care services for inpatients. We applied a cross-sectional retrospective approach to categorize the inpatients based on their diagnosis and procedures and then estimate the actual cost of health care services provided to inpatients during 2018 and compared it with the average cost of the health services. There was a considerable difference between DRG-based costing (SAR 269,663,897) and average costing (SAR 247,035,938). The Diagnosis Related Group costing was found to be more reliable and representative of the services provided to the patients and is recommended to be used for reimbursement purposes.
医疗保健系统旨在提供高质量的医疗服务，同时考虑到资源的有效利用和具有成本效益的干预措施。为了实现这些目标，需要使用科学工具或机制，在考虑降低成本之前，先对成本进行评估。基于疾病诊断相关分组的成本核算方法（病例组合）被认为是医疗保健领域首选的成本核算方法之一。延布的法赫德国王中央医院是吉赞地区唯一的三级医院，被选为基于病例组合的患者层面医疗服务成本核算的试点。该研究的目的是估算每个疾病诊断相关分组（DRG）的住院患者成本，并将其与已确定的住院患者医疗服务平均成本进行比较。我们采用了横断面回顾性方法，根据患者的诊断和治疗过程对患者进行分类，然后估算 2018 年为住院患者提供的实际医疗服务成本，并将其与医疗服务的平均成本进行比较。基于疾病诊断相关分组的成本核算（269663897 沙特里亚尔）与平均成本核算（247035938 沙特里亚尔）之间存在相当大的差异。基于疾病诊断相关分组的成本核算被认为更可靠，更能代表为患者提供的服务，建议将其用于报销目的。
