OBJECTIVE To observe the impact of drug-resistant bacterial infections on cost burden and payment of diseases under diagnosis-related group (DRG) payment system.
METHODS The data regarding the payments under health insurance DRG were collected from pilots of 6 cities in Shandong Province from 2019 to 2021. The patients were divided into the drug-resistant infection group and the non-drug-resistant infection group according to the type of infection and were matched 1:1 using propensity score matching (PSM) with age, sex, type of health insurance and major diagnosis categories as covariates. The medical cost burden, related DRG payment standards, coverage rate of actual medical cost, components of medical costs and consumption of medical resources were observed.
RESULTS The average hospitalization cost was 2.8 times in the drug-resistant infection group higher than that the non-drug-resistant infection group, the length of hospital stay was about 10 days, and the current hospitalization cost of only 19.12% of the patients with drug-resistant infections could be covered by DRG payment standards, far lower than 52.07% of the patients with non-drug-resistant infections (P < 0.05).
CONCLUSIONS The burden of cost of the patients with drug-resistant infections is remarkably higher than that of the patients with non-drug-resistant infections, however, the current DRG payment standards are hard to cover the actual medical cost. It is suggested that the DRG grouping and payment policies should be further optimized so as to raise the affordability of both the patients with drug-resistant infections and the hospital.
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