病种分值付费改革对患者住院费用影响的阶段性研究

Phased study on the impact of diagnosis-intervention packet payment on hospitalization expenses

目的探讨珠海市实施病种分值付费改革后住院患者人均费用及费用结构的变化趋势。方法用中断时间序列方法分析改革前2年和改革后2年珠海市住院患者人均费用及各分类费用占比(即每千元医疗费用中某分类费用值)数据,研究人均住院费用及费用结构的变化。结果住院患者人均费用在改革前后均呈线性变化趋势,改革后的即刻水平和回归线斜率没有明显改变,与改革前的趋势基本一致。实施病种分值付费后,各类别费用占比发生变化,其中综合医疗服务类、治疗类、中医类、西药类、血液及血液制品类、其他类费用占比趋势改变明显,P值均小于0.05;诊断类、康复类、中药类费用占比趋势改变不明显,但即刻水平有改变,诊断类水平改变量-13.649(P<0.001),康复类水平改变量-1.053(P<0.001),中药类水平改变量2.781(P<0.001);耗材类占比改革后的即刻水平和趋势改变均不明显。结论珠海市实施病种分值付费后,住院患者人均费用变化不明显,但费用结构明显改变。

Objective To explore the change trend of average hospitalization expense and cost structure of inpatients after the implementation of diagnosis-intervention packet(DIP)payment reform in Zhuhai.Methods The data of hospitalization expense and the proportion of each classification cost(i.e.the value of a classification cost per thousand yuan of medical cost)in Zhuhai before and after the reform were analyzed by interrupted time series method,and the changes of per capita hospitalization cost and cost structure were studied.Results The average hospitalization expense showed a linear change trend before and after the reform,and the immediate level and the slope of regression line did not change significantly after the reform,which was basically consistent with the trend before the reform.After the implementation of DIP,the proportion of various categories of expenses changed.Among them,the proportion of comprehensive medical services,treatment,traditional Chinese medicine,western medicine,blood and blood products,and other categories changed significantly,P values were less than 0.05.There was no obvious change in the proportion of expenses of diagnosis,rehabilitation and traditional Chinese medicine,but there was a change in the immediate level.The change in the level of diagnosis was-13.649(P<0.001),the change in the level of rehabilitation was-1.053(P<0.001),and the change in the level of traditional Chinese medicine was 2.781(P<0.001).The immediate level and trend change of the proportion of consumables after the reform was not obvious.Conclusions After the implementation of DIP payment in Zhuhai,the average expense of inpatients has not changed significantly,but the expense structure has changed significantly.