基于双重差分模型的日间手术单病种付费政策实施效果分析  

Analysis on the implementation effect of single disease payment policy for day surgery based on difference-in-differences model

作　　者：张洪成 潘建强 路航 高以焕 孔蕴馨 苗春霞 卓朗 Zhang Hongcheng;Pan Jianqiang;Lu Hang;Gao Yihuan;Kong Yunxin;Miao Chunxia;Zhuo Lang(Medical Insurance Office,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;School of Management,Xuzhou Medical University,Xuzhou 221004,China;School of Public Health,Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学附属医院医疗保险办公室,徐州221002 [2]徐州医科大学管理学院,徐州221004 [3]徐州医科大学公共卫生学院,徐州221004

出　　处：《中华医院管理杂志》2023年第5期332-336,共5页Chinese Journal of Hospital Administration

基　　金：国家社会科学基金(19BGL251)。

摘　　要：目的分析日间手术单病种付费政策(以下简称政策)实施效果,为日间手术的医保支付方式改革提供参考。方法收集某三级甲等医院2017—2019年的住院患者信息,将结直肠良性肿瘤和结节性甲状腺肿患者分别作为研究组和对照组,2017—2018年为政策实施前,2019年为政策实施后。采用双重差分模型,进行政策实施与否以及政策实施前后2次差分,分析政策实施后住院天数和住院费用等指标的变化。结果共纳入2419例患者,其中,对照组为927例结节性甲状腺肿患者,研究组为1492例结直肠良性肿瘤患者(政策实施前688例,政策实施后804例)。双重差分模型分析结果显示,政策实施后,结直肠良性肿瘤患者的住院天数下降56.53%,住院费用下降26.51%,自付费用下降26.66%,治疗类费用增加11.96%,药品类费用下降50.29%,耗材类费用下降20.23%。结论政策实施可降低患者住院天数、住院费用和自付费用,优化住院费用结构,提高诊疗效率,有助于医院从规模扩张型向质量效益型的转变。Objective To analyze the implementation effect of single disease payment policy for day surgery(hereinafter referred to as the policy),for references for the reform of medical insurance payment.Methods By collecting the information of inpatients from 2017 to 2019 in a tertiary hospital,the research group took patients with colorectal benign tumor and nodular goitre as the policy implementation group and the control group respectively.2017-2018 was the pre implementation stage of the policy,and 2019 was the post implementation stage of the policy.The difference-in-differences(DID)model was used to analyze the changes in indicators such as length of stay and hospitalization expenses after policy implementation,under whether the policy is implemented or not,as well as before or after policy implementation.Results A total of 2419 patients were included,including 927 patients with nodular goiter in the control group and 1492 patients with colorectal benign tumors in the policy implementation group(688 patients before the policy implementation and 804 patients after the policy implementation).The results of DID showed that the hospital days for patients with colorectal benign tumor decreased by 56.53%,the hospitalization expenses decreased by 26.51%,the out-of-pocket expenses decreased by 26.66%,the treatment expenses increased by 11.96%,the drug expenses decreased by 50.29%and the consumables expenses decreased by 20.23%after the implementation of the policy.Conclusions The implementation of the policy could reduce length of stay,hospitalization expenses and out-of-pocket expenses,optimize the structure of hospitalization expenses,improve the efficiency of hospital diagnosis and treatment,and help the hospital realize its transformation from a size expansion to a quality and benefit expansion.

关 键 词：日间手术 单病种付费 双重差分模型 结直肠良性肿瘤 医疗保险 

分 类 号：R197.323[医药卫生—卫生事业管理]