基于间断时间序列的中医类医院支付方式改革初步效果分析

Analysis on the Preliminary Effect of Payment Reform in a Chinese Medicine Hospital Based on Interrupted Time Series

目的:在全国推进DIP支付方式改革背景下,实证评价典型中医类医院支付方式改革的初步效果。方法:收集S市某中医类医院2016—2022年共20.75万人次的住院病案首页数据,对改革前后住院医疗费用等主要指标进行差异分析。设置DIP支付方式改革实施、新冠疫情发生和静态管理3个干预时点,运用间断时间序列分析改革初步效果;应用logistic回归探索主要影响因素,并结合关键知情者访谈等提出完善建议。结果:研究发现改革后高住院费用组、高自费费用组和高床日费组占比均增加,改革前后床日费整体呈上升趋势;年龄、已婚、手术次数、平均手术级别、死亡离院是住院费用、自费费用、床日费的共同影响因素。结论:DIP支付方式改革初期对住院医疗费用的调控作用不明显。人口结构变动、新冠疫情干预和中医类医院手术倾向均易导致住院医疗费用上升,同时政策解读不足、医务人员激励缺失等因素均影响改革效果。建议中医类医院DIP支付方式改革需进一步强化政策解读并转变固化模式,注重建立医务人员正向激励机制,增设中医特色考核指标,进一步发挥中医特色优势,提升中医服务内涵和质量。

Objective:In the background of the national promotion of DIP insurance payment reform,using empirical data to evaluate the initial effects of payment reforms in typical traditional Chinese medicine hospitals.Methods:It collected inpatient case data from a Chinese medicine hospital in S city,encompassing a total of 207500 cases from 2016 to 2022,and the differences between before and after the reform were analyzed using key indicators such as medical costs.Interrupted time series was applied to analyze the initial effects of the reform based on three intervention time points:reform implementation,epidemic development and static management.Logistic regression was applied to explore the main influencing factors,and recommendations for refinement were made based on the results of the key informant interviews.Results:It was found that the percentage of the high hospitalization cost group,high self-pay cost group and high bed-day cost group increased after the reform.There was an overall increasing trend in bed-day costs after the reform.Age,being married,operation times and average grade of operations,and death were the common influences.Conclusion:The initial stage of the DIP insurance payment reform was not effective in regulating medical costs.Demographic changes,strong intervention in epidemics,and the tendency of Chinese medicine hospitals to perform surgeries all tend to lead to an increase in hospitalization costs.At the same time,factors such as the shortage of policy interpretation and the lack of incentives for medical staff have affected the effectiveness of the reform.It was suggested that the DIP insurance payment reform of the Chinese medicine hospitals should be further promoted by strengthening the interpretation of policies and changing the solidification model,establishing positive incentives for medical staff,and adding indicators of traditional Chinese medicine characteristics.This will further fully leverage the advantages of Chinese medicine characteristics and enhance the substance and quality of Chinese medicine services.