关键词: 银屑病, 住院费用, 疾病诊断相关分组

Abstract: Objective Psoriasis is a common autoimmune disease,which brings great economic burden to patients' families and society. Currently,many regions implement payment by diagnosis related groups（DRGs）.By analyzing the real data of discharged patients with psoriasis in a grade-A tertiary hospital in Tianjinin 2021,this study aims to propose a DRGs negotiation plan for win-win results among medical insurance,hospitals and patients. Methods The hospitalization costs of patients who were first diagnosed with psoriasis（ICD10 code：L40） in the Hospital Affiliated to Tianjin Academy of Traditional Chinese Medicine in 2021 were extracted,and compared with the DRGs payment standard published by the Tianjin medical insurance department,and SPSS 24 statistical software was used for analysis. Results In 2021,the total hospitalization cost of psoriasis patients was 8 376 310.23 yuan,and the average cost was 13 007.14（7 011.46,17 562.32）yuan.Among them,the self-funded part of the single room fee was 152 560.00 yuan,accounting for 1.86% of the total income.If it was calculated according to the DRGs payment method, all 645 people would have been divided into JS1 group,including 27 people in JS11 group,421 people in JS13 group and 197 people in JS15 group,the total payment amount would have been 7 053 413.35 yuan,which the income was 1 322 896.88 yuan less to actual expenses,a loss of 15.79%. After removing the rate cases,there was no statistically significant difference the two payment methods both in JS11 group and JS15 group,but the fee-for-service in JS13 group was statistically significant higher than that paid by DRGs（P<0.01）,and higher than that in JS11 group with more serious complications,which was contrary to the payment principle of DRGs.The difference in hospitalization costs among different types of psoriasis was statistically significant（F=23.716,P<0.01）. There was no statistically significant difference in the cost between erythrodermic psoriasis and pustular psoriasis,while psoriasis vulgaris had the highest number of cases and the lowest average cost. The psoriasis vulgaris accounted for 63.60% in JS11 group,81.30% in JS13 group and 94.40% in JS15 group,and the difference was statistically significant（χ²=25.395,P<0.01）,but there was no statistical significance between JS13 group and JS11 group（P>0.025）. Conclusions As the single room fee is included in the payment scope of DRGs,it will increase the loss of the hospital and crowd out the cost of disease treatment,so we suggest that it should continue to be charged at self-payment. Based on the ICD10 diagnostic code and textbook,psoriatic arthritis and psoriatic juvenile arthritis are adjusted into the JS1 group. According to the skin lesion characteristics of psoriasis,it is recommended to refer to other skin damaging diseases,fully consider the severity of psoriasis,and adjust the payment level.

Key words: Psoriasis, Hospitalization costs, Diagnosis related groups