DIP支付方式改革对山东省县级中医医院住院服务的影响研究:基于DID的实证研究

Evaluation of the Impact of DIP Insurance Payment Reform on Inpatient Services in County-level Traditional Chinese Medicine Hospitals in Shandong Province:A DID Based Empirical Analysis

目的:DIP支付方式改革对山东省县级中医医院住院服务的影响进行评价,为中医医院实施DIP医保支付方式改革提供建议。方法:使用双重差分模型对山东省87家县级中医医院住院服务情况进行评价。结果:与非试点地区县级中医医院住院单位相比,试点地区县级中医院出院人数提升了22.5%,使用中药饮片的出院人数提升了36.4%,使用中医医疗技术的出院人数提升了51.9%;住院收入提升了26.7%,住院中医医疗服务项目住院药品收入43.7%。但使用医疗机构中药制剂的出院人数、住院药品收入、平均住院天数和次均住院费4个指标与非试点城市相比,没有明显差异。结论:DIP医保支付方式改革下的县级中医医院应通过提高医疗服务能力,提升竞争力;通过提高费用控制力度,减轻患者负担;通过注重中医药特色发挥,提升患者满意度。本研究为DIP支付方式改革下县级中医医院提供了一定的政策启示。

Objective:To evaluate the impact of Diagnosis-Intervention Packet(DIP)insurance payment reform on inpatient services in county-level traditional Chinese medicine hospitals in Shandong Province and provide recommendations for implementing DIP insurance payment reform in TCM hospitals.Methods:A Difference-in-Differences(DID)model was used to evaluate the inpatient services of 87 county-level traditional Chinese medicine hospitals in Shandong Province.Results:Compared to non-pilot areas,the number of discharges was increased by 22.5%in the pilot areas of county-level traditional Chinese medicine hospitals.The number of discharges using Chinese herbal medicine was increased by 36.4%,and the number of discharges using traditional Chinese medical techniques was increased by 51.9%.In addition,inpatient revenue was increased by 26.7%,and revenue from inpatient traditional Chinese medical services was increased by 43.7%.However,there were no significant differences in the number of discharges using prepared traditional Chinese medicine,inpatient medication revenue,average length of stay,and average inpatient cost between the pilot and non-pilot cities.Conclusion:Under the DIP insurance payment reform,county-level traditional Chinese medicine hospitals should improve the medical service capabilities and enhance competitiveness.It is also needed to increase cost control efforts to reduce the burden on patients,and emphasize the unique characteristics of traditional Chinese medicine to enhance patient satisfaction.It provides certain policy implications for county-level traditional Chinese medicine hospitals under DIP payment reform.