Objective  To explore the main categories and changing directions of hospitalization expenses of gynecological tumors, and provide strategies and suggestions for effectively controlling hospitalization expenses and improving the payment scheme of medical insurance fund.

Methods  The expense information of patients discharged from Huzhou Central Hospital from January 2020 to December 2022 was collected, and analyzed by the payment method of structural variation and disease diagnosis related groups (DRG) with grey correlation, and the correlation degree was observed.

Results  From 2020 to 2022, the average hospitalization cost of 2 138 gynecological tumor patients showed a downward trend. The hospitalization cost structure of patients showed that surgical and laboratory expenses accounted for a relatively high proportion, while nursing and treatment expenses accounted for a relatively low proportion. The changes in the hospitalization structure of patients showed that material costs were gradually decreasing, while operating costs, bed fees, pathology fees, and nursing fees were gradually increasing. Diagnosis and treatment fees, drug fees, radiation fees, testing fees, treatment fees, surgery fees, and other expenses were first decreasing and then increasing. In the hospitalization expenses of gynecological tumors from 2020 to 2022, the most closely related expenses were surgical expenses, drug expenses, and laboratory expenses, while the least related expenses were bed expenses, nursing expenses, and treatment expenses. The proportion of patient hospitalization expenses was basically consistent with the degree of correlation. The structural change rate of hospitalization expenses for gynecological tumors from 2020 to 2022 was 13.67%, with a structural change rate of 14.61% from 2020 to 2021 and 10.77% from 2021 to 2022. The direction of structural changes showed that from 2020 to 2022, there were positive changes in operating fees, bed fees, pathology fees, and nursing fees, with significant changes in surgical fees. The largest contribution rate of changes in the hospitalization cost structure of gynecological tumors from 2020 to 2022 was surgical expenses, accounting for 37.29%, followed by examination expenses, accounting for 13.08%. The contribution rates of various expenses to the structural changes of average hospitalization expenses varied during different time periods. From 2020 to 2021, the largest contribution rate of hospitalization expense structural changes was surgical expenses, accounting for 33.05%, followed by drug expenses, accounting for 12.05%. From 2021 to 2022, the largest contribution rate of hospitalization expense structural changes was surgical expenses, accounting for 48.00%, followed by drug expenses, accounting for 16.85%. Correlation analysis showed that the hospitalization expenses of patients were related to medical insurance type and length of stay (P<0.05).

Conclusion  The average hospitalization cost of gynecological tumor patients has been effectively controlled, and their clinical hospitalization costs are gradually rationalized. However, material and surgical costs still have a significant impact on the hospitalization costs of patients, indicating that the labor value of clinical medical personnel has increased less. DRG payment can control clinical medical expenses to a certain extent, and further optimization is needed to improve supporting policies, enhance the technical value of medical personnel, and strengthen the management of medical consumables.

1.王文娇, 贾琎蕊. 基于灰色关联和结构变动度分析医疗改革对肺癌胸腔镜手术患者住院费用的影响[J]. 中国病案, 2023, 24(5): 81-84. [Wang WJ, Jia QR. Analysis of the impact of medical reform on hospitalization costs of lung cancer patients undergoing thoracoscopic surgery based on grey correlation and structural change degree[J]. Chinese Medical Record, 2023, 24(5): 81-84.] DOI: 10.3969/j.issn.1672-2566.2023.05.029.

2.黎蔺娴, 肖久庆, 侯戬炜. 北京市医药分开、医耗联动综合改革对住院费用及结构的影响研究——基于T医院的实证分析[J]. 中国卫生政策研究, 2020, 13(8): 15-22. [Li LX, Xiao JQ, Hou JW. A study on the impact of the comprehensive reform of medical separation and medical consumption linkage on hospitalization costs and structure in beijing: an empirical analysis based on T hospital[J]. Chinese Health Policy Research, 2020, 13(8): 15-22.] DOI: 10.3969/j.issn.1674-2982.2020.08.003.

3.姚书婷, 鄢金柱, 柯玉芳, 等. 低分子肝素联合物理治疗预防妇科肿瘤术后下肢深静脉血栓形成的网状Meta分析[J]. 医学新知, 2022, 32(2): 108-119. [Yao ST, Yan JZ, Ke YF, et al. Low molecular weight heparin plus physiotherapy techniques in prevention of deep vein thrombosis in gynecological cancer patients undergoing major abdominopelvic surgery: a network Meta-analysis[J]. Yixue Xinzhi Zazhi, 2022, 32(2): 108-119.] DOI: 10. 12173/j.issn.1004-5511.202109007.

4.Wolfson RL, Abdelaziz A, Rankin G, et al. DRG afferents that mediate physiologic and pathologic mechanosensation from the distal colon[J]. Cell, 2023, 186(16): 3368-3385. DOI: 10.1016/j.cell.2023.07.007.

5.Zhang C, Hu MW, Wang XW, et al. scRNA-sequencing reveals subtype-specific transcriptomic perturbations in DRG neurons of PirtEGFPf mice in neuropathic pain condition[J]. Elife, 2022, 11: e76063. DOI: 10.7554/eLife.76063.

6.陈凤磊, 梁冰, 钱静, 等. DRG付费改革对广西某三甲医院患者住院费用影响研究[J]. 中国医院, 2023, 27(1): 53-55. [Chen FL, Liang B, Qian J, et al. A study on the impact of DRG payment reform on hospitalization expenses of patients in a tertiary hospital in Guangxi[J]. Chinese Hospital, 2023, 27(1): 53-55.] DOI: 10.19660/j.issn.1671-0592.2023.01.14.

7.Bhandari R, Sharma A, Kuhad A. Novel nanotechnological approaches for targeting dorsal root ganglion (DRG) in mitigating diabetic neuropathic pain (DNP)[J]. Front Endocrinol (Lausanne), 2022, 12: 790747. DOI: 10.3389/fendo.2021.790747.

8.刘卫刚, 张仲海, 刘志军, 等. 基于DRG+疾病风险调整的三级综合医院住院相关费用分析[J]. 中国病案, 2023, 24(7): 61-64. [Liu WG, Zhang ZH, Liu ZJ, et al. Analysis of hospitalization related expenses in tertiary comprehensive hospitals based on DRG+disease risk adjustment[J]. Chinese Medical Record, 2023, 24(7): 61-64.] DOI: 10.3969/j.issn.1672-2566.2023.07.021.

9.贾晓倩, 赵允伍, 王晓松, 等. DRG改革下某公立医院2021年第一季度住院费用分析[J]. 中国医院, 2023, 27(1): 59-61. [Jia XQ, Zhao YW, Wang XS, et al. Analysis of hospitalization expenses for a public hospital in the first quarter of 2021 under DRG reform[J]. Chinese Hospital, 2023, 27(1): 59-61.] DOI: 10.19660/j.issn.1671 -0592.2023.01.16.

10.崔媛媛, 陈晖. 基于DRG的北京市属医院小儿肺炎住院费用结构分析[J]. 中国病案, 2023, 24(7): 95-98. [Cui YY, Chen H. Analysis of hospitalization cost structure for pediatric pneumonia in Beijing municipal hospitals based on DRG[J]. Chinese Medical Record, 2023, 24(7): 95-98.] DOI: 10.3969/j.issn.1672-2566.2023.07.031.

11.王雪玲, 陈佳林, 时晓萱, 等. DRG付费下皮肤病专科医院面临的挑战与对策[J]. 中国麻风皮肤病杂志, 2023, 39(9): 653-657. [Wang XL, Chen JL, Shi XX, et al. Challenges and countermeasures faced by dermatology specialty hospitals under DRG payment[J]. Chinese Journal of Leprosy and Dermatology, 2023, 39(9): 653-657.] DOI: 10.12144/zgmfskin202309653.

12.王文君, 贾晓倩, 周道平, 等. DRG高倍率病例与正常倍率病例差异及住院费用灰色关联分析[J]. 中国医院, 2023, 27(5): 55-58. [Wang WJ, Jia XQ, Zhou DP, et al. Grey correlation analysis of the difference between DRG high magnification cases and normal magnification cases and hospitalization costs[J]. Chinese Hospital, 2023, 27(5): 55-58.] DOI: 10.19660/j.issn.1671-0592.2023.05.15.

13.游凯, 杨柳, 齐伟, 等. 基于DRG的肺癌患者住院费用结构分析及相关影响因素探讨[J]. 肿瘤预防与治疗, 2023, 36(8): 663-668. [You K, Yang L, Qi W, et al. Analysis of hospitalization cost structure and related influencing factors of lung cancer patients based on DRG[J]. Cancer Prevention and Treatment, 2023, 36(8): 663-668.] DOI: 10.3969/j.issn.1674-0904.2023.08.006.

14.伍达锋. 基于DRG分组下的子宫平滑肌瘤住院费用影响因素分析[J]. 中国病案, 2022, 23(2): 61-64. [Wu DF. Analysis of factors influencing hospitalization costs for uterine leiomyoma based on DRG grouping[J]. Chinese Medical Record, 2022, 23(2): 61-64.] DOI: 10.3969/j.issn.1672-2566.2022.02.022.

15.袁源, 欧荣, 万映利. 基于DRG的重庆市早产儿住院病例费用分析[J]. 医学与社会, 2020, 33(3): 47-50. [Yuan Y, Ou R, Wan YL. Cost analysis of inpatient cases of premature infants in Chongqing based on DRG[J]. Medicine and Society, 2020, 33(3): 47-50.] DOI: 10.13723 /j-yxysh.2020.03.010.

16.胡云鹤, 于凡, 李爱东. DRG视角下医耗联动综合改革对肿瘤患者住院费用的影响[J]. 解放军医院管理杂志, 2020, 27(6): 555-558, 579. [Hu YL, Yu F, Li AD. The impact of comprehensive reform of medical consumption linkage from the perspective of DRG on the hospitalization expenses of cancer patients[J]. Journal of Hospital Management of the People's Liberation Army, 2020, 27(6): 555-558, 579] DOI: 10.16770/J.cnki.1008-9985. 2020.06.017.

17.白飏, 路伟, 陈鹏, 等. 海南某市试点医院总额预算下按DRG支付方式改革成效分析[J]. 中国医院, 2023, 27(12): 19-22. [Bai Y, Lu W, Chen P, et al. Analysis of the effectiveness of DRG payment reform under the total budget of a pilot hospital in a certain city of Hainan[J]. Chinese Hospital, 2023, 27(12): 19-22.] DOI: 10.19660/j.issn.1671-0592.2023.12.05.

18.潘春华, 吕新兵, 张亚芬, 等. DRG视角下北京某医院消化病中心医耗联动改革效果评价[J]. 中国病案, 2021, 22(6): 15-19. [Pan CH, Lyu XB, Zhang YF, et al. Evaluation of the effect of medical consumption linkage reform in a digestive disease center of a hospital in Beijing from the perspective of DRG[J]. Chinese Medical Record, 2021, 22(6): 15-19.] DOI: 10.3969/j.issn.1672-2566. 2021.06.007.

19.周小明, 李娟, 沈承武, 等. 2019-2021年某院药品使用与费用研究[J]. 中国医院, 2023, 27(10): 79-81. [Zhou XM, Li J, Shen CW, et al. A study on the use and cost of drugs in a certain hospital from 2019 to 2021[J]. Chinese Hospital, 2023, 27(10): 79-81.] DOI: 10.19660/j.issn.1671-0592.202310.21.

20.周鹏飞, 李运明, 杨孝光, 等. 国内外DRG研究应用概述和医院开展DRG付费方式改革的作用及存在问题探讨[J]. 卫生软科学, 2023, 37(2): 6-10. [Zhou PF, Li YM, Yang XG, et al. Overview of DRG research and application at home and abroad, and exploration of the role and existing problems of hospital DRG payment reform[J]. Health Soft Science, 2023, 37(2): 6-10.] DOI: 10.3969/j. issn.1003-28000.2023.02.002.

21.吴学智, 李捷, 邓淑娟, 等. DRG付费改革对攀枝花市某三甲医院普外科医保患者费用的调控效果分析[J]. 医学与社会, 2022, 35(3): 76-79. [Wu XZ, Li J, Deng SJ, et al. Analysis of the regulatory effect of DRG payment reform on the cost of general surgery medical insurance patients in a tertiary hospital in Panzhihua City[J]. Medicine and Society, 2022, 35(3): 76-79.] DOI: 10.13723/j.yyysH.2022-03.016.

22.王旖旆, 曾雁冰, 郜凯华, 等. 美国DRG付费改革历程对我国医保支付方式改革的启示[J]. 中华医院管理杂志, 2023, 39(2): 93-96.[Wang YB, Zeng YB, Gao KH, et al. The enlightenment of the DRG payment reform process in the United States on the reform of China's medical insurance payment methods[J]. Chinese Journal of Hospital Management, 2023, 39(2): 93-96.] DOI: 10.3760/cma.j.cn111325-20220920-00818.

23.于婷, 严波. DRG付费方式下公立医院结余分析与运营[J]. 中国医院, 2022, 26(10): 64-66. [Yu T, Yan B. Analysis and operation of surplus in public hospitals under DRG payment method[J]. Chinese Hospital, 2022, 26(10): 64-66.] DOI: 10.19660/j.issn.1671-0592.20210.18.

24.苏广全, 陈慧, 桂双英, 等. 基于德尔菲法构建医疗机构药品目录管理评价指标体系[J]. 药物流行病学杂志, 2023, 32(1): 30-35. [Su GQ, Chen H, Gui SY, et al. Construction of hospital medicine list management index system based on Delphi method[J]. Chinese Journal of Pharmacoepidemiology, 2023, 32(1): 30-35.] DOI: 10.19960 /j.issn.1005-0698.202301005.

25.徐尚华, 董四平, 蒋凌, 等. 医疗保险支付方式改革背景下地市级三级甲等医院院内"三医联动"工作机制探索[J]. 华西医学, 2023, 38(12): 1885-1889. [Xu SH, Dong SP, Jing L, et al. Exploration of the "Medical-lnsurance-Medicine Linkage" working mechanism in a municipal tertiary hospital under the background of medical insurance payment reform[J]. West China Medicine Journal, 2023, 38(12): 1885-1889.] DOI: 10. 7507/1002-0179.202311100.