基于双重差分模型的DRG付费对医院运营效率影响研究  

Research on the Influence of Implementing DRG Payment on the Operating Efficiency of Hospitals Based on the Difference-in-differences Model

作　　者：吴雪枫 周典[1,2] 方秀斌[1] 汪卓赟[1] 田帝 周苑 张博[1] 吴烨 耿敏[1] Wu Xuefeng;Zhou Dian;Fang Xiubin(The Second Hospital of Anhui Medical University,Hefei,Anhui,230601,China;不详)

机构地区：[1]安徽医科大学第二附属医院,安徽合肥230601 [2]安徽医科大学卫生管理学院,安徽合肥230032 [3]安徽医科大学第一附属医院,安徽合肥230022

出　　处：《中国医院管理》2023年第5期18-22,共5页Chinese Hospital Management

基　　金：国家卫生健康委医院管理研究所重点项目(YL ZLXZ22K001);安徽省社会科学创新发展研究课题(2020CX107);安徽省卫生健康软科学研究项目(2020WR02011);安徽省卫生健康委重点科研项目(AHW2021a022);合肥市软科学研究项目(2021017);安徽医科大学校科研基金项目(2021xkj294);合肥市医疗卫生“借转补”研发项目(J2020Y04)。

摘　　要：目的评估实施按疾病诊断相关分组(DRG)付费对安徽省某三级甲等综合医院经济运营和医疗质量的政策效应。方法采用描述性统计法和双重差分法进行实证分析,参考国家三级公立医院绩效考核指标选取经济运营和医疗质量两类核心指标,将2020年(实施前)与2021年(实施后)实施与未实施DRG的医保类型进行对比,分析改革前后的指标变化。结果经平衡趋势检验及安慰剂检验,抗菌药物消耗量、抗菌药物使用强度、临床路径入径率、次均住院费用、住院次均药品费、住院次均材料费差异有统计学意义(P<0.10),其余指标差异无统计学意义(P>0.10)。结论DRG付费显著提升了医疗机构经济运营效率,而医疗质量未受影响。Objective It mainly aimed to evaluate the effects of the policy on the economic operation and medical quality of a Grade A tertiary general hospital in Anhui Province after the implementation of DRG payment.Methods An empirical analysis was conducted with the methods of descriptive statistics and Difference-in-Differences(DID).According to indicators for the performance appraisal of national tertiary public hospitals,the two core indicators of economic operation and medical quality were selected,and a comparison was made between medical insurance types with DRG payment and those without DRG payment in 2020(before implementation)and 2021(after implementation),to analyze changes in the indicators before and after the reform.Results After balance trend test and placebo test,it was concluded that there were significant differences in the regression coefficients of antibacterial drug consumption,antibacterial drug use intensity,clinical pathway entry rate,average cost of hospitalization,average drug cost for each hospitalization,and average material cost for each hospitalization(P<0.10).No significant difference was observed in the regression coefficients of the other indicators(P>0.10).Conclusion DRG payment significantly improved the efficiency of the economic operation of the medical institution,but its medical quality was not affected.

关 键 词：疾病诊断相关分组 运营效率 双重差分模型 

分 类 号：R197.3[医药卫生—卫生事业管理]