基于双重差分法评价按病种分值付费(DIP)实施效果

Evaluation of the implementation effect of diagnosis-intervention packet(DIP)based on differences-in-differences method

[目的]分析按病种分值付费对脑血管疾病住院患者住院费用及天数的影响。[方法]选择广州市某大型三甲医院2017年7月15日-2019年3月31日脑血管疾病(ICD编码为:I60-I69)住院患者的病案首页费用信息。采用双重差分法对患者的住院总费用、住院天数、药品费用、西药费用、中药费用进行净效应评估,并基于疾病诊断相关分组权重、DRGs分组的治疗方式对患者进行分组,分析不同组别的住院费用情况,评价DIP的实施效果。[结果]DIP实施后患者的住院总费用较实施前下降1657.87元。疑难病例组的住院总费用下降5946.90元,药品费用下降596.45元,西药费用下降521.18元;手术组的药品费用下降1555.22元、西药费用下降1683.14元;非手术室操作组的住院总费用下降8594.75元,住院天数下降6.74天,以上差异均有统计学意义。[结论]按病种分值付费改革有利于减轻患者的直接经济负担、提高医疗机构的运营效率,强化医疗机构的自主管理。在医保政策的制定过程中,应保证门诊等支付方式改革的协同性,警惕住院费用转移;在医疗机构的精细化管理过程中,应特别重视病案首页质量。

Objective To analyze the effect of diagnosis-intervention packet(DIP)on hospitalization expenses and days of inpatients with cerebrovascular diseases.Methods Cost information on the front page of medical records of inpatients with cerebrovascular diseases(ICD code:I60-I69)in a large-scale 3A grade hospital in Guangzhou from July 15,2017 to March 31,2019 was selected.Differences-in-differences method was used to assess the net effect of total hospitalization expenses,hospitalization days,medicine cost,cost of western medicine,cost of Chinese medicine.The patients were divided into groups based on weights of Diagnosis Related Groups and treatment of DRGs to analyze the hospitalization expenses of different groups and evaluate the effect of DIP implementation.Results The total hospitalization expenses of patients decreased by 1657.87 yuan after DIP implementation compared with that before DIP.The total hospitalization expenses of the difficult case group decreased by 5946.90 yuan.Medicine cost decreased by 596.45 yuan.Cost of western medicine decreased by 521.18 yuan.Medicine cost of the surgery group decreased by 1555.22 yuan and cost of western medicine decreased by 1683.14 yuan.The total hospitalization expenses of the non-surgery group decreased by 8594.75 yuan and the number of hospitalization days decreased by 6.74 days.Above differences were statistically significant.Conclusions Reform of diagnosis-intervention packet is conducive to reducing the direct financial burden of patients,improving the operational efficiency of medical institutions and strengthening the autonomous management of medical institutions.In the process of formulating medical insurance policy,it is necessary to ensure the coordination of the reform of payment methods such as outpatient service and be alert to the shifting of hospitalization expenses.In the process of fine management of medical institutions,the quality of the front page of medical records should be given special attention.