摘要目的:探索依据年龄因素对医保费用支付标准进行调整，使其更符合临床实际资源消耗。方法:收集某院2021年1月1日至2021年12月31日出院患者54 535例住院患者病历首页数据。首先通过配对 t-检验方法，验证通过费用调整模型调整前后的支付标准额度与实际住院费用之间的统计学差异。其次，将实际费用分别与模型调整后费用和现行标杆费用(调整前)两组数据进行配对差分，通过比较两组的标准差，来判断调整前后费用标准与实际费用之间的差异。 结果:通过正态得分Blom公式对实际费用、调整后费用、现行标杆费用数据进行正态转化。将正态化后的实际费用分别与调整后标杆费用和现行标杆费用进行配对 t-检验分析，实际费用与调整后费用和现行标杆费用的 P值分别为0.97、0.93均大于0.05，两者均能够反映临床实际资源消耗。但是，通过分析两组配对数据成对差分后的标准差来判断费用调整效果，调整后支付标准与实际费用之间标准差为0.68，低于未调整组与实际费用之间标准差的0.70。 结论:按照年龄因素的费用支付调整模型，能够以患者年龄为依据合理调整费用支付标准，并验证了调整后的支付标准相较于现行标准更能够准确地反映临床实际资源消耗，但支付调整模型仍有一定的改进空间。

abstractsObjective:To analyze the adjustment of the amount of medical insurance reimbursement with the addition of the age factor, making the system more in line with the actual clinical resource consumption.Methods:Data were collected from the first page of medical records of 54 535 inpatients discharged from hospital between January 1 th, 2021 and December 31 th, 2021.First, the paired t-test was used to verify any statistical difference between the standard payment amounts before and after adjustment based on the model and the actual hospitalization expenses.Secondly, the actual cost was compared with the cost after the model-based adjustment and the current benchmark cost(before adjustment), respectively.The standard deviations of the two groups were compared to assess the difference between the benchmark cost and the actual cost before and after adjustment. Results:Through the Blom formula, the actual cost, adjusted benchmark cost and current benchmark cost data were normalized.After normalization, the actual expenses and the adjusted benchmark cost as well as the actual expenses and the current benchmark cost were compared, respectively, using the paired t-test, producing a P value of 0.97 for the former pair and a P value of 0.93 for the latter pair, both greater than 0.05, and the benchmark cost before and after adjustment could reflect the actual clinical resource consumption.However, the effect of benchmark cost adjustment was assessed by analyzing the standard deviation of the difference between paired values of the two groups.The standard deviation of paired values between the actual expense and the adjusted benchmark cost was 0.68, lower than the standard deviation of paired values between the actual expense and current benchmark cost, which was 0.7. Conclusions:With the inclusion of the age factor, the model can reasonably adjust the current benchmark cost based on the patient's age and verify that the adjusted benchmark cost can more accurately reflect the actual clinical resource consumption compared with the current standard.However, further improvement of the payment adjustment model is still needed.