湖北省某三甲医院以乳腺良性肿瘤为例的按病种付费分析

Effect Evaluation of Single Disease Quota Paymentin a Class Three Hospital of HuBei:Taking Benign Breast Tumor as an Example

目的评价湖北省按病种付费方式改革的效果。方法采用湖北省某三甲医院改革前后的住院患者就诊样本数据,通过建立双重差分模型比较实行按病种付费与未实行按病种付费患者的住院费用、住院日等指标的变化情况。结果按病种付费改革后,住院费用下降了22.03%(P<0.01),药品费平均下降了42.39%(P<0.05),耗材费下降了77.15%(P<0.01),有效控制了总体医疗费用,并对药品费、耗材费的影响显著,但按病种付费纳入率降低了12.86%,住院天数增加了0.67天(P<0.10)。结论湖北省按病种付费方式的实施有效的控制了降低了住院费用,住院天数也更加合理,但还应认识到单病种付费的不足并探索制定更合理的付费标准。

Objective To evaluate the effect of payment reform in HuBei Province.Methods the data collected from the inpatient department in a hospital in HuBei were used to compare changes of average hospitalization expenses,hospitalization days by establishing a difference-in-difference(DID)model.Results After the reform,the overall medical expenses decreased by 22.03%(P<0.01),the drug fee decreased by 42.39%(P<0.05),and the consumables fee decreased by 77.15%(P<0.01).The quota payment policy effectively controlled the overall medical expenses.Drug fee and Medical Supplies fee weresignificantly affected(P<0.01).However,the rate of inclusion by Single disease quota payment reduced by 12.86%.And the hospitalization days was increased by 0.67 days(P<0.10).Conclusion The quota payment policy in HuBei effectively controlled the overall medical expenses.and the hospitalization days are more reasonable.However,it should also recognize the lack of Single disease quota payment and explore the development of more reasonable payment standards.