基于间断时间序列分析的中医和西医医院同类疾病住院费用差异研究

Comparison of hospitalization expenses for identical diseases between traditional Chinese medicine and Western medicine hospitals based on interrupted time-series analysis

目的 在全面深化医保支付方式改革背景下,分析政策干预和新冠疫情对中医和西医医院同类疾病住院费用的影响,为促进医院与医保高质量协同发展、减轻患者经济负担提供证据。方法 收集上海市某区全部23家公立医院2014年1月至2020年12月间84个月0.99万人次女性相关恶性肿瘤患者的病案数据。基于政策颁布和疫情出现两个干预时点构建间断时间序列模型,比较中医和西医医院间同类疾病均次费用的变化趋势和组间差异。结果 西医医院女性相关恶性肿瘤的均次费用在政策干预后由上升转为下降趋势,受疫情影响均次费用再次上升;中医医院同类疾病均次费用相对呈上升趋势,疫情影响下均次费用波动较大。结论 政策干预对西医医院费用的控制效果较好,中医医院费用上涨明显。新冠疫情对不同类型医院同类疾病患者住院费用影响较大。未来亟需构建契合中医发展和服务特点的支付模式,控制费用不合理增长;同时完善公立医院配套补偿措施和监管机制,以有效应对突发公共卫生事件对医院合理运行和患者合法权益的威胁。

Objective In light of the comprehensively implemented reform of medical insurance payments,this study analyzed the impact of the payment intervention and COVID-19 pandemic on hospitalization expenses for identical diseases between traditional Chinese medicine(TCM)and Western medicine hospitals,to provide evidence to promote high-quality coordinated development of hospitals and insurance while reducing patient load.Methods From January 2014 to December 2020,we gathered data including 9900 individual medical records of woman-related malignant tumors(WMT)from all 23 public hospitals in a district of Shanghai.We developed an interrupted time-series analysis model based on the above two interventions,to compare the inpatient average per-time expenses between different hospitals and different groups.Results The average per-time expenses of WMT in Western hospitals changed from rising to declining after the policy intervention,and increased again during the pandemic.In TCM hospitals,the expenses continued to increase and fluctuated after the pandemic.Conclusion The policy intervention has achieved a good effect on controlling the cost of Western hospitals,rather than the significant increase in TCM hospitals.Meanwhile,the COVID-19 pandemic has had a significant impact on hospitalization expenses.It’s urgent to develop a payment model that fits the development and characteristics of TCM,to control the unreasonable growth of expenses.Moreover,the financial compensation methods and supervision mechanism of public hospitals should be improved to effectively resist the threat of public health emergencies for the development of hospitals and the legitimate rights of patients.