基于间断时间序列分析DIP改革对医疗费用的影响——以山东省滨州市为例

The Impact of DIP Reform on Medical Costs Based on Interrupted Time Series Analysis——Taking Binzhou City of Shandong Province as an Example

目的:本研究评估滨州市DIP改革前后患者住院费用的变化,并比较DIP政策在二级及以下医疗机构和三级医疗机构之间的效果差异,旨在基于真实世界数据评估医保政策效果,并为政策持续优化提供证据。方法:选取滨州市2020年10月至2023年12月的以急性心内膜下心肌梗死为主要诊断住院患者费用数据,采用间断时间序列模型分析DIP政策执行前后患者住院费用的变化趋势,并通过Spearman相关分析探究构成费用对住院总费用变化的贡献程度。结果:分析显示,改革前急性心内膜下心肌梗死住院患者的总费用及各部分费用均无显著变化;DIP改革后短期内,总费用呈每月降低2152.25元的趋势(P<0.05),长期来看无显著变化,但DIP改革后住院总费用和医疗服务费相关性最高(r=0.881)、和耗材费相关性最低(r=0.757)。就不同级别医疗机构来看,二级及以下医疗机构改革前总费用无显著变化,改革后的瞬间降费效果明显,长期来看每月降低297.918元(P<0.05),主要来源于检查检验费、医疗服务费和耗材费;三级医疗机构改革前后总费用并无显著变化。结论:滨州市DIP政策在短期内对住院费用降低有显著影响,长期无显著变化;DIP的实施优化了住院费用结构,在一定程度上体现了医疗服务价值;二级及以下医疗机构对DIP政策较为敏感。

Objective:This study assessed the changes in hospitalisation costs before and after the DIP reform in Binzhou City,and compared the differences in the effectiveness of the DIP policy between secondary and lower level and tertiary medical institutions,in order to assess the effectiveness of medical insurance policies based on real-world data and provide evidence for the continuous optimisation of the policy.Methods:The cost data of hospitalised patients with acute subendocardial myocardial infarction as the main diagnosis in Binzhou City from October 2020 to December 2023 were selected to analyse the trend of inpatient costs before and after the implementation of the DIP policy by using the interrupted time-series model,and the extent to which the constituent costs contributed to the changes in the total inpatient costs was explored by Spearman's correlation analysis.Results:The analysis showed that there was no significant change in the total costs and the component costs of inpatients with acute subendocardial myocardial infarction before the reform.After the DIP reform,the total costs showed a trend of decreasing by 2152.25 yuan per month in the short term(P<0.05),and there was no significant change in the long term.However,the total costs of hospitalisation after the DIP reform had the highest correlation with the cost of healthcare services(r=0.881)and the lowest with the cost of consumables(r=0.757).In terms of different levels of medical institutions,there is no significant change in the total cost of secondary and lower medical institutions before the reform,and the instantaneous effect of fee reduction after the reform is obvious,with a monthly reduction of 297.918 yuan in the long term(P<0.05),which is mainly from the examination and test fee,healthcare service fee and consumable fee.There is no significant change in the total cost before and after the reform of the tertiary medical institutions.Conclusion:DIP policy in Binzhou City has a significant effect on the reduction of inpatient costs in the short term,and there is no significant change in the long term.The implementation of DIP policy has optimised the structure of inpatient costs,which reflects the value of healthcare services to a certain extent.The secondary and lower medical institutions are more sensitive to the DIP policy.