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基于双重差分模型的专病管理政策效果分析

Analysis of the effects of specialized disease management policy based on difference-in-differences model

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目的 分析专病管理政策(以下简称政策)实施效果,为公立医院加强运营管理,提升业财融合水平提供参考.方法 收集某大型综合三甲医院2022年1月—2023年6月的住院患者信息,将国家三级公立医院绩效考核关注的十类单病种中的四类纳入专病管理作为研究组,剩余六类作为对照组,采用双重差分模型,分析专病管理患者住院均次费用、平均住院日、均次药品费用、均次耗材费用、均次检查治疗费用等相关指标在政策实施前后的变化.且按医保类型分类,进一步分析不同医保类型下政策实施效果的区别.结果 共纳入22 457例患者,其中研究组为5 879例患者(政策实施前3 164例,政策实施后2 715例),对照组为19 741例患者.双重差分模型分析显示,政策实施后,专病管理患者的均次住院费用下降32.7%,平均住院天数下降31.4%,药品费用下降49.5%,耗材费用下降24.2%,检查治疗费下降29.2%.且相较于非武汉市医保患者,武汉市医保患者相关指标下降幅度更大.结论 政策实施能有效降低患者就医负担,提升医疗治疗效率,有助于医院精细化管理方式,加深业财融合,向精益化运营转型.
Objective Analyze the implementation effects of the specialized disease management policy(hereinafter re-ferred to as the policy)to provide reference for strengthening operational management and enhancing the integration of business and finance in public hospitals.Methods Patient information of inpatients from a large comprehensive tertiary hospital from Jan-uary 2022 to June 2023 was collected.Four out of ten single diseases focused on by the national tertiary public hospital perform-ance assessment were included in the study group for specialized disease management,while the remaining six were used as the control group.A difference-in-differences model was adopted to analyze the changes in relevant indicators such as per capita inpa-tient expenses,average length of stay,per capita drug expenses,per capita consumable expenses,and per capita examination and treatment expenses before and after the policy implementation.Additionally,the effects of policy implementation were further analyzed based on different medical insurance types.Results A total of 22 457 patients were included,with 5 879 patients in the study group(3 164 cases before policy implementation and 2 715 cases after policy implementation),and 19 741 patients in the control group.The difference-in-differences model analysis showed that after the policy implementation,per capita inpatient expenses for specialized disease management patients decreased by 32.7%,average length of stay decreased by 31.4%,drug ex-penses decreased by 49.5%,consumable expenses decreased by 24.2%,and examination and treatment expenses decreased by 29.2%.Moreover,compared to patients under non-Wuhan medical insurance,patients under Wuhan medical insurance experi-enced a greater reduction in related indicators.Conclusion The implementation of the policy effectively reduces the burden on patients seeking medical care,improves medical treatment efficiency,contributes to hospital refined management methods,deep-ens the integration of business and finance,and facilitates the transition towards leaner operations.

Specialized disease managementDifference-in-differences modelDRG payment reformOperations man-agement

曾绍颖、田野、刘波、齐磊、楼阳、李艳红、南京辉

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华中科技大学同济医学院附属协和医院 湖北武汉 430022

专病管理 双重差分模型 DRG支付改革 运营管理

湖北省卫健委委托项目

WJ2023D001

2024

现代医院
广东省医院协会

现代医院

影响因子:1.332
ISSN:1671-332X
年,卷(期):2024.24(6)