基于双重差分法的总额预付制度对住院费用影响评估  

Evaluation of the Effects of Global Budget Policy on Hospitalization Expenditure by Matching Difference-in-difference Model

作　　者：陈治水[1] 冷家骅[1] 刘忆[1] 刘晶[1] 王薇[1] CHEN Zhi-shui;LENG Jia-hua;LIU Yi;et al(Peking University Cancer Hospital/Key Laboratory of Carcinogenesis and Transitional Research, Ministry of Education, Beijing, 100142, China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所.恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国医院管理》2018年第4期53-55,共3页Chinese Hospital Management

摘　　要：目的评估总额预付实施4年后次均住院费用的控费效果。方法利用2008年8月—2016年7月的住院病案数据,应用双重差分法,以2012年8月为节点,未实施总额预付人群为对照组,实施的为干预组,分别计算次均住院费用和次均药品费用的净政策效应。结果总额预付制度的推进,次均住院费用的综合效应为-4 414.79元,次均药品费用的综合效应为199.79元。结论总额预付制度的推广一定程度上实现了对总费用的调控,减轻了肿瘤患者的住院负担,但同时药占比是个管理难点,多种付费方式的铺开需要考虑到肿瘤药物治疗的特异性。Objective To identify the policy impact of global budget after 4 years’ implementation on hospitalization expenditure. Method Based on Hospital Information System（HIS）,records between Aug. 2008 and Jul. 2016 were collected. Cutoff date was Aug. 2012,and DID method was applied to evaluate the net effect between the policy group and the matched group. Result The implementation of global budget has brought with a net reduction of ￥4 414.79 for the average hospitalization expense and a net increase of ￥199.79 for the average drug cost. Conclusion The global budget policy leads to the cost control and patient burden relief to a certain extent. But the medicine is a difficult field of management,thus the consideration of the distinctness of oncological treatment is essential to complex payment reform practice.

关 键 词：总额预付 住院次均费用 肿瘤 双重差分法 

分 类 号：R197.1[医药卫生—卫生事业管理]