天津市腹膜透析按人头付费改革实施效果评价

Evaluation of Impact of Peritoneal Dialysis Capitation in Tianjin

目的:分析腹膜透析按人头付费改革对腹膜透析使用率、患者健康产出及医疗费用的影响,为优化医疗机构管理、深化医保支付方式改革提供参考。方法:基于天津市2018—2020年肾透析门特就诊数据,进行描述性分析和双重差分模型分析,评价改革对腹膜透析人数、健康监测检查频次、门特就诊次数及门特医疗费用的效果。结果:腹膜透析按人头付费实施后,腹膜透析人数与健康监测检查频次提高,就诊次数和医疗费用无显著改变。结论:医保支付方式改革激励了医疗机构开展腹膜透析的积极性,有利于进行患者健康监测,对医疗费用的影响还需长期随访评估。

Objective:The paper analyzes the impact of peritoneal dialysis(PD)capitation on PD utilization rate,patient health outcome and medical expenses,and provides a reference for optimizing hospital management and deepening medical insurance payment reform.Methods:Based on claim data of kidney dialysis outpatient special disease patients in Tianjin City from 2018 to 2020,descriptive analysis and difference in difference model were carried out to evaluate the impact of the reform on the number of PD patients,the frequency of health monitoring examinations,the number of outpatient special disease visits and the medical expenses.Results:After PD capitation was implemented,the number of PD patients and the frequency of health monitoring examinations both increased,and the number of outpatient visits and medical expenses did not change significantly.Conclusion:The reform of medical insurance payment stimulated the initiative of hospitals to carry out PD,promote health monitoring,while the impact on medical expenses needs to be evaluated by long-term follow-up.