DRG/DIP支付改革、费用控制与影响机制——基于19个地区抽样数据的多期双重差分分析  

DID Analysis Based on Sampling Data from 19 Regions

作　　者：朱凤梅 Zhu Fengmei(Institute of Economics,Chinese Academy of Social Sciences,Bejing 100836,China)

机构地区：[1]中国社会科学院经济研究所

出　　处：《社会保障评论》2023年第5期54-67,共14页Chinese Social Security Review

摘　　要：目前,DRG/DIP支付改革已成为控制医疗费用的快速上涨、引导医疗资源配置的重要政策工具,研究其政策效果,对进一步完善医保支付方式改革具有重要的现实意义。本文基于中国医疗保险研究会2013—2019年抽样数据库,采用多期双重差分法重点考察DRG/DIP支付改革的控费效果,并结合实际情况,对其背后的影响机制进行分析。研究发现,DRG和DIP均显著降低了参保患者单次住院费用,但对其因同种疾病住院的年总费用没有影响。究其原因,缩短住院天数、分解住院已成为医疗机构规避单次支付价格限制的主要手段。上述控费效果在不同参保类型患者、不同等级医院具有显著差异。就DRG支付改革来说,职工医保患者是主要受益者,三级医院是降费的主要承担者。本研究的结论支持DRG/DIP支付改革预期,但也为医保支付改革提出了风险防范方向。Currently,DRG/DIP payment reform serves as a pivotal policy instrument for curbing the escalation of medical expenses and directing the distribution of healthcare resources.Assessing its policy eficacy is crucial for the ongoing refinement of health insurance payment methods.Utilizing sample data from the China Health Insurance Research Association between 2013 and 2019,this study employs a multiperiod DID methodology to scrutinize the cost-control impact of DRG/DIP payment reform and to explore its underlying mechanisms.The findings reveal that both DRG and DIP substantially reduce the cost per hospitalization for insured patients,yet they have no effect on the total annual hospitalization costs for the same medical condition.This is primarily due to healthcare providers opting for shorter hospital stays and hospitalization segmentation as strategies to circumvent individual payment caps.These cost-control impacts vary significantly across insurance types and hospital tiers.Specifically,under DRG payment reform,patients covered by UEBMI benefit the most,while tertiary hospitals bear the brunt of cost reductions.The study's conclusions affirm the prospects of DRG/DIP payment reform and offer insights into risk-mitigation strategies for future medical insurance payment reforms.

关 键 词：医保支付方式改革 DRG/DIP 医疗费用 分解住院 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]