Volume 1,Issue 2
Research on the Balance Mechanism between Medical Quality and Cost under the DRG Payment Model in Daytime Colonoscopy Surgery
Objective: Based on the DRG payment model, this study focuses on daytime colonoscopy surgery. Through big data and statistical methods, it analyzes the balance mechanism between medical quality and cost, constructs a refined management model, and provides a basis for hospital resource optimization and medical insurance payment policy formulation. Methods: This study integrates data from the Tianjin colonoscopy DRG disease group (GK31, GK35), uses descriptive statistics, correlation analysis, and other methods, and combines DRG indicators such as CMI, CCI, and TCI to analyze case costs, hospital stays, and resource consumption characteristics. Results: The study found that the cost difference between different departments is up to 127 times, indicating uneven resource allocation and an imbalance in the cost consumption index. After regional collaborative intervention, the CCI of the sample department dropped to 0.95, and the average hospital stay was reduced by 15.2%. Conclusion: Constructing an “indicator monitoring-resource coordination-cost control” mechanism can achieve a balance between quality and cost. It is recommended to improve the DRG indicator system, strengthen big data supervision, and promote the standardization of daytime surgery.
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