基于双重差分法视角评估按病种分值付费对心血管病种患者的影响  

Evaluation of the impact of Diagnosis-Intervention Packet on patients with cardiovascular diseases from the perspective of difference-in-difference method

作　　者：胡芳芳 陈望忠[2] 袁向东 钟晓[4] HU Fang-fang;CHEN Wang-zhong;YUAN Xiang-dong;ZHONG Xiao(School of Health Management,Southern Medical University,Guangzhou,Guangdong 510515,China;不详)

机构地区：[1]南方医科大学卫生管理学院,广东广州510515 [2]南方医科大学校报编辑部 [3]南方医科大学附属华南医院(广东省人民医院) [4]深圳市龙岗中心医院

出　　处：《现代预防医学》2022年第17期3181-3186,共6页Modern Preventive Medicine

基　　金：广东省科技计划项目(2021B1212020011)。

摘　　要：目的分析按病种分值付费政策对心血管病种患者实施效果并提供相关建议。方法以广东省某大型三甲综合医院DIP政策实施前后收治的64970份心血管病种患者为研究样本,通过描述性统计和双重差分法,分析两种不同医保支付方式(广州医保、其他医保)对相关医疗指标的影响。结果按病种分值付费政策实施后,广州医保患者人均住院费用从49060.62元下降到46984.24元(t=-6.924,P<0.001),自负金额减少2104.67元(t=-10.654,P<0.001),住院天数下降0.40天(t=-8.824,P<0.001),三个指标的差异均具有统计学意义,而其他医保支付方式患者的这三个指标在两个时期的差异无统计学意义。在费用结构中有明显变化幅度的分别是综合医疗服务费(t=53.403,P<0.001)、诊断费(t=50.198,P<0.001)、治疗费(t=22.804,P<0.001)、西药费(t=-12.488,P<0.001)、血浆和血浆制品费(t=-7.93,P<0.001)、耗材费(t=-17.901,P<0.001)以及其他费用(t=-115.076,P<0.001),差异均具有统计学意义,变化幅度最大的是耗材费,同比减少5.53%。以“风险级别”为分层标准对人均住院费用和住院天数进行双重差分法分层分析,政策效果仅发生在人均住院天数中“中低风险级别”和“没有出现死亡病例”两组病例。结论按病种分值付费改革有利于增强医院自主管理意识,减轻参保人员个人负担水平,优化费用结构,但仍需加强控制重点费用类别,并未能充分体现医疗服务价值和达到促进分级诊疗目的,需提高支付标准的科学性和精准性。Objective To analyze the effect of Diagnosis-Intervention Packet(DIP)policy on patients with cardiovascular diseases and offer some relative suggestions.Methods A total of 64970 patients with cardiovascular diseases admitted before and after the implementation of the DIP policy in a large tertiary general hospital in Guangdong Province were taken as the research sample.Two different medical insurance payment methods(Guangzhou medical insurance and other medical insurance)were analyzed by descriptive statistics and difference-in-difference method for the impact on related medical indicators.Results After the implementation of DIP policy,the per capita hospitalization expenses of Guangzhou medical insurance patients decreased from 49060.62 yuan to 46984.24 yuan(t=-6.924,P<0.001),the self-pay amount decreased by 2104.67 yuan(t=-10.654,P<0.001),and the hospitalization days decreased by 0.40 days(t=-8.824,P<0.001).The three indicators were statistically significant,However,there was no significant difference in the three indexes of patients with other medical insurance payment methods in the two periods.In the cost structure,the obvious changes were comprehensive medical service fee(t=53.403,P<0.001),diagnosis fee(t=50.198,P<0.001),treatment fee(t=22.804,P<0.001),western medicine fee(t=-12.488,P<0.001),plasma and plasma products fee(t=-7.93,P<0.001),consumables fee(t=-17.901,P<0.001)and other expenses(t=-115.076,P<0.001),the difference was statistically significant,and the consumables fee was the largest change,with a decrease of 5.53%over the same period.Taking"risk level"as the stratification standard,the DID method was used to analyze the average hospitalization expenses and hospitalization days.The policy effect only occurred in the two groups of cases of"medium and low risk level"and"no death cases"in the per capita hospitalization days.Conclusion The DIP policy reform is conducive to enhancing the hospital’s self-management awareness,reducing the personal burden of insured personnel and optimizing the cost str

关 键 词：按病种分值付费 双重差分法 心血管病种 风险级别 

分 类 号：R197[医药卫生—卫生事业管理]