A Case Study on the Efficiency of Medical Insurance Cost Accounting in Public Hospitals Under DRG Policy — Taking XX Hospital as an Example

Sang Linying

doi:10.62177/apemr.v2i2.243

Authors

Sang Linying Second Affiliated Hospital of Bengbu Medical College

DOI:

https://doi.org/10.62177/apemr.v2i2.243

Keywords:

DRG Payment, Data Envelopment Analysis, Disease Cost Accounting, Case Study

Abstract

This study focuses on a tertiary public hospital in XX, employing Data Envelopment Analysis (DEA) and cost accounting methods for specific diseases to systematically evaluate its cost efficiency performance and optimization paths in DRG payment reform. By constructing a dual-dimensional model of "internal time series analysis + external benchmark comparison," combined with the BCC model and Malmquist index, the study analyzes the dynamic changes in hospital efficiency from 2019 to 2023. The findings are as follows: (1) The overall technical efficiency (TE) of the hospital is 0.82, indicating an efficiency loss of 18%, primarily due to redundant drugs and medical supplies (15.2%) and the case mix index (CMI) gap (5.6%); (2) High-weight DRG diseases (such as interventional treatment for acute myocardial infarction) have a cost overrun of 16.3%, significantly dragging down overall efficiency; (3) Standardizing clinical pathways and collaborating with regional resources can improve efficiency to industry benchmark levels. This case provides a theoretical and operational framework for detailed cost management in individual hospitals.

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