DIP实施前后患者住院费用结构变化的实证研究——以广东省10家公立医院为例

An Empirical Study on the Change of Inpatient Cost Structure Before and After the Implementation of DIP Policy——Taking Ten Public Hospitals in Guangdong Province as an Example

目的:通过研究2016年至2020年广东省实施DIP政策的10家医院住院患者费用数据,找出影响不同级别医院住院费用结构变动的主要因素,并分析各因素对住院费用结构变动的影响程度。方法:运用结构变动度分析法对5年住院数据进行结构变动度分析,运用描述性统计对比分析二、三级医院在DIP政策实施前后各项费用的年均变动情况。结果:DIP政策实施前,影响二级医院住院费用结构变动的主要因素是医疗服务收入和药费,影响三级医院的主要因素是耗材费和药费;DIP政策实施后,影响二级医院的主要因素是检验检查费和药费,影响三级医院的主要因素是医疗服务收入。结论:DIP政策实施后,检查检验费对二级医院住院费用结构变动贡献度最大,医疗服务收入对三级医院住院费用结构变动贡献度最大。五年来,医疗服务收入占二级医院住院收入比例上升明显,但受DIP政策影响较小,费用结构有待优化;医疗服务收入占三级医院住院收入比例整体上升,且受DIP政策影响明显,更能反映出临床资源消耗情况及体现医护人员的医疗技术价值。

Objective:The paper studies the inpatient cost data of 10 hospitals implementing DIP policy in Guangdong Province from 2016 to 2020,identifies the main factors affecting the change of inpatient cost structure of different hospitals,and analyzes the influence of each factor on the change of inpatient cost structure.Methods:The degree of structural variation analysis method was used to analyze the five-year inpatient data,and descriptive statistics were used to compare and analyze the annual changes of various expenses in secondary and tertiary hospitals before and after the implementation of DIP policy.Results:Before the implementation of DIP policy,the main factors affecting the structural changes of inpatient expenses in secondary hospitals were medical service revenue and medicine expenses,while the main factors affecting tertiary hospitals were consumables and medicine expenses.After the implementation of DIP policy,the main factors affecting secondary hospitals are medical examination and medicine expenses,and the main factors affecting tertiary hospitals are medical service revenue.Conclusion:After the implementation of DIP policy,medical examination expenses contributed the most to the change of inpatient cost structure in secondary hospitals,and medical service revenue contributed the most to the change of inpatient cost structure in tertiary hospitals.During the five years,although the proportion of medical service revenue in the inpatient revenue of secondary hospitals has increased significantly,it is less affected by DIP policy,and the cost structure of secondary hospitals needs to be optimized.The proportion of medical service revenue in the inpatient revenue of tertiary hospitals has increased as a whole and is obviously affected by DIP policy,which can better reflect the consumption of clinical resources and the medical technology value of medical staff.