Full
Outline
To explore the influencing factors of payment differences in patients undergoing spine-related surgeries under the Diagnosis-Related Groups（DRG）payment system, and to provide evidencefor improving hospital medical insurance fund surplus and promoting high-quality hospital development.
We collected data from 1 798 inpatients undergoing spine-related surgeries and grouped under the DRG system, along with their medical insurance settlement cost information, at a large Grade-A tertiary hospital in Guangxi from January 1,2022 to December 31,2024. Descriptive statistics, univariate analysis, and multivariate regression models were employed to analyze factors influencing medical insurance payment differences. Structural equation modeling was further applied to validate correlations among variables.
Univariate analysis revealed that age, average length of stay, ADRG group, insurance fund type, case type, presence of complications, primary diagnosis group, and VBP participation status were significant factors influencing medical insurance payment differences in spine-related surgical patients（P<0.05）. The results of multiple linear regression analysis indicated that the top three factors influencing payment differences were ADRG group（β=-1.704,t=-29.369,P<0.001）, centralized procurement status（β=-1.244,t=-17.705,P<0.001）, and case type（β=-1.085,t=-11.257,P<0.001）. Structural equation modeling showed ADRG group as the most influential factor with a path coefficient of 0.55, followed by procurement policy（0.36）and case type（0.21）.
ADRG grouping is the primary determinant of payment differences. Under DRG payment systems, healthcare authorities should optimize disease group weights to reflect actual medical resource consumption and technical complexity. They should actively promote centralized volume procurement of high-value consumables while strengthening synergies between DRG payment and procurement policies. Hospitals need to optimize clinical pathways, control medical costs through rational diagnosis and treatment, thereby improving DRG payment difference levels.
45
20
| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
关闭全屏
No. 86 Xueyuan South Road, Haidian District, Beijing
010-62662699(Operation and Technical Support)
qkjq@cast.org.cn
Copyright © 2025 China Association for Science and Technology. All rights reserved. For all open access content, the relevant licensing terms apply.
Sponsored by the Office of the Leading Group for Cybersecurity and Informatization of CAST, and supported by Science and Technology Review Publishing House
