河南省DRG试点医院的控费效果分析

Cost control effect analysis of DRG pilot hospitals in Henan province

目的对河南省DRG试点医院实行DRG付费方式的控费效果进行评估分析,为河南省医改的推进工作提供参考依据。方法基于河南省某DRG试点城市2017—2021年公立医院医保结算系统数据,选取某DRG试点医院为实验组,采用随机抽样法选取同期未实行DRG的一家医院为对照组,比较2017—2021年实验组和对照组医疗费用的变化情况,采用双重差分法对DRG控制医疗费用的效果进行评估。结果DRG支付实施当年实验组的住院费用总额和个人负担费用由上升转为下降,降幅分别为6.4%和12.8%。DRG支付实施1年后实验组的住院费用总额、医保基金支付费用和个人负担费用显著下降,降幅分别为22.6%、25.6%和16.9%。结论DRG试点医院的住院患者医疗费用控费效果显著,DRG试点城市付费改革取得初步成效,为河南省DRG付费改革的推进工作提供了参考依据。

Objective To evaluate and analyze the cost control effect of DRG payment method implemented in pilot hospitals in Henan Province,and to provide reference for the promotion of medical reform in Henan Province.Methods Based on the data of the medical insurance settlement system of a public hospital in a DRG pilot city in Henan Province from 2017-2021,a DRG pilot hospital was selected as the experimental group,and a hospital that did not implement DRG in the same period was selected as the control group using the random sampling method to compare the changes in medical costs between the experimental and control groups from 2017-2021,and the effect of DRG on controlling medical costs was evaluated using the double difference method.Results The total cost of hospitalization and the cost borne by individuals in the experimental group changed from increasing to decreasing in the year of DRG payment implementation,with a decrease of 6.4%and 12.8%,respectively.One year after the implementation of DRG payment,the total cost of hospitalization,the cost borne by the health insurance fund and the cost borne by individuals in the experimental group decreased significantly,with a decrease of 22.6%,25.6%and 16.9%,respectively.Conclusion The inpatient medical cost control effect of DRG pilot hospitals is remarkable,and the initial results of DRG payment reform in pilot cities have been achieved,providing a reference basis for the promotion of DRG payment reform in Henan Province.