Objective To evaluate and analyze the cost control effect of DRG payment method implemented in pilot hospitals in Henan Province, and to provide reference for the promotion of medical reform in Henan Province. Methods Based on the data of the medical insurance settlement system of a public hospital in a DRG pilot city in Henan Province from 2017-2021, a DRG pilot hospital was selected as the experimental group, and a hospital that did not implement DRG in the same period was selected as the control group using the random sampling method to compare the changes in medical costs between the experimental and control groups from 2017-2021, and the effect of DRG on controlling medical costs was evaluated using the double difference method. Results The total cost of hospitalization and the cost borne by individuals in the experimental group changed from increasing to decreasing in the year of DRG payment implementation, with a decrease of 6.4% and 12.8%, respectively. One year after the implementation of DRG payment, the total cost of hospitalization, the cost borne by the health insurance fund and the cost borne by individuals in the experimental group decreased significantly, with a decrease of 22.6%, 25.6% and 16.9%, respectively. Conclusion The inpatient medical cost control effect of DRG pilot hospitals is remarkable, and the initial results of DRG payment reform in pilot cities have been achieved, providing a reference basis for the promotion of DRG payment reform in Henan Province.

Background: Non-alcoholic fatty liver disease (NAFLD) represents a large and growing public health problem. Insulin resistance (IR) plays a crucial role in the pathogenesis of NAFLD. The aim of this study was to determine the association of triglyceride-glucose (TyG) index, TyG index with body mass index (TyG-BMI), lipid accumulation product (LAP), visceral adiposity index (VAI), triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL-c) and metabolic score for IR (METS-IR) with NAFLD in older adults and to compare the discriminatory abilities of these six IR surrogates for NAFLD.Methods: This cross-sectional study included 72,225 subjects aged >= 60 years living in Xinzheng, Henan Province, from January 2021 to December 2021. The data were collected from the annual health examination dataset. Logistic regression models were used to examine the relationships between the six indicators and NAFLD risk. The area under the receiver operating characteristic curve (AUC) was used to compare the discriminatory ability of different IR surrogates for NAFLD under the influence of potential risk factors.Results: After adjusting for multiple covariates, compared with the first quintile, the odds ratios (ORs) and 95% confidence intervals (CIs) of the highest quintiles of TyG-BMI were the most obvious (OR:43.02, 95% CI:38.89-47.72), followed by the METS-IR (OR:34.49, 95% CI:31.41-37.95). Restricted cubic spline analysis reported that there were non-linear positive association and dose-response relationship between 6 IR surrogates and NAFLD risk. Compared with other IR-related indicators (LAP, TyG, TG/HDL-c and VAI), TyG-BMI showed the highest AUC (AUC:0.8059;95% CI:0.8025-0.8094). Additionally, METS-IR also had a high predictive performance for NAFLD, and the AUC was greater than 0.75 (AUC:0.7959;95% CI:0.7923-0.7994). Conclusion: TyG-BMI and METS-IR had pronounced discrimination ability to NAFLD, which are recommended as complementary markers for the assessment of NAFLD risk both in clinic and in future epidemiological studies.

Background The prevalence of obesity, hypertension and diabetes is increasing. Hypertension and diabetes are common complications. Additionally, obesity and hypertension–diabetes comorbidity (HDC) are both closely related to insulin resistance. The aim of this study was to determine the association of obesity indicators with HDC in elderly individuals. Methods This retrospective cohort study included 74,955 subjects aged ≥ 60 years living in Xinzheng, Henan Province, from January 2011 to December 2019. The data were collected from the annual health examination dataset. Cox proportional hazard regression models and competing-risk survival regression models were used to examine the relationships between the three indicators and HDC risk. Results After 346,504 person-years of follow-up, HDC developed in 9,647 subjects. After further adjustments for confounders and death competing risks, compared with a body mass index (BMI) of 18.5–23.9 kg/m 2 , the fully adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of BMI < 18.5, 24–27.9 and ≥ 28 kg/m 2 for HDC morbidity were 0.651(0.538,0.788),1.00,1.396(1.336,1.459) and 1.769(1.666,1.878), respectively. Moreover, participants with abdominal obesity measured via waist circumference (WC) or waist-to-height ratio (WtHR) had a higher risk of HDC (HR:1.513; 95% CI: 1.45,1.578 and HR:1.412;95% CI: 1.353,1.473), respectively, than participants with low WC or with low WtHR. In the joint analyses, the highest risk was observed in participants who were overweight and who had central obesity (HR: 1.721; 95% CI: 1.635, 1.811) compared with the nonoverweight and noncentral obesity groups. Conclusions Increased BMI, WC and WtHR were associated with an increased risk of HDC. There was an additive interaction between general body adiposity (as measured via BMI) and central obesity (as measured via WC and WtHR) for HDC. Therefore, reasonable control of BMI, WC and WtHR may be an effective measure to prevent HDC among elderly individuals.

目的 评价河南省某三甲公立医院按病种付费实施的效果,为河南省按病种付费模式的推广提供依据.方法 采用河南省某三甲公立医院2019～2020年患者病案首页的数据,通过描述性统计以及双重差分法分析患者平均住院费用、住院天数、住院次数等指标,评价按病种付费政策的实施效果.结果 按单病种付费政策实施后,患者人均住院费用从38399.31元降到了31302.56元(t=13.898,P<0.001),平均住院天数下降0.94天(t=14.661,P<0.001),再入院率减少12.18％(t=6.729,P<0.001),三个指标的差异均有统计学意义.在费用体系中有明显变化的是耗材费(t=-199.295,P=0.000)、药费(t=9.429,P<0.001)、检查化验费(t=-18.292,P<0.001)、手术费(t=63.759,P=0.000)、治疗费(t=-40.413,P<0.001)以及其他费用(t=56.984,P=0.000),差异均有统计学意义(P<0.001).护理费有小幅下降,但差异无统计学意义(P>0.05).政策组患者药品费占比低于对照组(t=3.138,P<0.001),差异有统计学意义.双重差分结果显示患者的平均住院费用、住院天数、住院次数均有下降,差异有统计学意义(P<0.001).结论 相较于按服务项目付费,医院按病种付费模式不仅控费效果显著,而且可以有效控制患者的住院天数以及再入院率,但费用结构中重点费用的提高应引起足够的重视.