基于双重差分法的DRG付费对中医医院的影响研究
The impact of DRGs payment on Traditional Chinese Medicine hospitals:Based on difference-in-difference analysis
郭慧君 1刘晶 1胡广宇 2郝一炜 3郝新梅 1王亚楠 1朱惠东 1李秋艳1
作者信息
- 1. 中国中医科学院西苑医院 北京 100091
- 2. 中国医学科学院卫生政策与管理研究中心 北京 100020
- 3. 首都医科大学附属北京地坛医院 北京 100102
- 折叠
摘要
目的:评估按疾病诊断相关分组(DRG)付费对中医医院住院患者例均总费用、费用结构、住院时长、出院人数及中医特色的影响.方法:以某中医类国家区域医疗中心为研究对象,使用双重差分回归模型(DID)分析付费改革政策实施前后医保患者(干预组)与非医保患者(对照组)的各项指标差异,通过平行趋势检验和安慰剂检验证实模型可靠性和稳定性.结果:例均住院总费用、病例数、住院天数、医疗服务收入占比、饮片收入占比等十一项指标的DID交互项系数显著(P<0.05),费用指标回归系数均小于0.饮片使用率、中医非药物疗法收入占比等四项指标DID交互项系数不显著(P>0.05).结论:DRG付费政策显著降低付费病组例均总费用,其中耗材、医技费用下降显著,费用结构优化,中药饮片费用占比略微下降.应持续关注DRG付费对中医医院影响,进一步扩大样本范围,跟踪分析政策影响,全面评价DRG付费政策对我国中医医疗机构的影响.
Abstract
Objective:This study aims to evaluate the impact of Diagnosis-Related-Groups(DRGs)payment on the average total cost,length of stay,service volume,effectiveness,and characteristics of traditional Chinese medicine(TCM)hospitals.Methods:A national medical center specializing in TCM was selected as the research subject.The Difference-in-Difference Model(DID)was utilized to analyze the differences in various indicators between insured patients(intervention group)and uninsured patients(control group)before and after the implementation of the payment reform policy.The reliability and stability of the model were verified through parallel trend tests and placebo tests.Results:The coefficients of DID interaction terms for eleven indicators including average total hospitalization cost,number of cases,length of stay,proportion of medical service revenue,and proportion of herbal medicine revenue were significant(P<0.05).The DID interaction term coefficients for four indicators including herbal medicine usage rate and proportion of non-pharmacological TCM therapy revenue were not significant(P>0.05).Conclusion:DRG payment significantly reduced the per-admission cost,with significant decreases in consumables and medical technology expenses,optimizing cost structure,and a slight decrease in the proportion of herbal medicine costs.It is necessary to further expand the sample size,track policy impacts,and comprehensively evaluate the effects of DRG payment on TCM hospitals in China.
关键词
DRG付费/中医医院/双重差分模型(DID)Key words
DRG payment/Traditional Chinese Medicine hospitals/Difference-in-Difference Model(DID)引用本文复制引用
基金项目
国家中医药管理局监测统计中心2024年度深化医改中医药政策研究自选课题(YGZXKT2024026")
中国中医科学院西苑医院(XYZX0404-08)
出版年
2024
NETL
NSTL
万方数据