基于间断时间序列分析的中医优势病种支付方式改革效果研究——基于S市的实证研究

Effectiveness of payment method reform for traditional Chinese medicine advantageous diseases:An empirical study from city S based on interrupted time series analysis

目的:实证评价中医优势病种支付方式改革成效,为完善中医支付方式提供科学依据。方法:收集S市试点改革的所有中医类医院2022年1月—2023年8月出院患者的中医病案数据,依据22个优势病种编码筛选病例;基于改革实施时点构建间断时间序列模型,纵向和横向分析二、三级医院改革效果及差异。结果:二级医院改革时床日费增长219.05元,改革后次均住院费用和次均中医类费用均呈上升趋势;三级医院改革后次均自费费用和床日费呈下降趋势,平均住院天数和次均中医类费用呈上升趋势,均相对二级医院明显。结论:不同级别医院改革效果存在差异。建议动态调整病种支付标准,建立差异化评价指标,并持续监测改革的长期成效,完善中医优势病种支付方式。

Objective:To empirically assess the effectiveness of the payment reform for traditional Chinese medicine(TCM)advantageous diseases and provide a scientific foundation for optimizing the payment method in TCM.Methods:Data on TCM cases of patients discharged from January 2022 to August 2023 were collected from all TCM hospitals piloting the payment reform for TCM advantageous diseases in city S.Cases were screened according to the TCM disease codes of the 22 pilot diseases.An interrupted time series model was constructed based on the time point of reform implementation to analyze the effect of the reform in the pilot hospitals vertically.Additionally,the model compared the differences in effect between second-and third-tier TCM hospitals horizontally.Results:In secondary hospitals,the bed day cost increased by 219.05 yuan during the reform period,and both the average hospitalization cost per admission and average TCM cost per admission showed an upward trend after the reform.In tertiary hospitals,the average out-of-pocket cost per admission and bed day cost decreased following the reform,while the average length of hospital stay and average TCM cost per admission increased.These trends were more pronounced in comparison to secondary hospitals.Conclusion:The reform effects varied across different hospital levels.It is recommended to dynamically adjust the payment standards for disease categories,establish differentiated evaluation metrics,and continuously monitor the long-term outcomes of the reform to further optimize the payment methods for TCM advantageous diseases.