DIP改革对医疗服务质量的影响研究  

Study on Impact of Diagnosis-Intervention Packet Reform on the Quality of Healthcare

作　　者：张馨予 严佳琦 王瑞欣 吕大伟 钱梦岑 应晓华[1] Zhang Xinyu;Yan Jiaqi;Wang Ruixin(School of Public Health,Fudan University,Shanghai,200032,China)

机构地区：[1]复旦大学公共卫生学院,上海200032 [2]上海市医疗保障局,上海200125

出　　处：《中国医院管理》2023年第12期16-19,共4页Chinese Hospital Management

基　　金：国家自然科学基金面上项目(72074051);首都医科大学国家医疗保障研究院面上项目(YB2020B01)。

摘　　要：目的分析按病种分值付费(Diagnosis-Intervention Packet,DIP)改革后医疗服务质量的变化,为完善我国医保支付方式改革提供依据。方法收集某DIP改革国家试点城市2017年7月—2021年6月的首批试点医疗机构城镇职工基本医疗保险参保住院患者的病案首页数据,纳入3个死亡相关指标和2个再入院相关指标,考虑患者特征进行风险调整后,采用t检验比较其在2019年7月实施DIP改革前后的差异。结果经风险调整后,DIP改革后住院手术患者死亡率、DIP低风险组住院患者死亡率、30天内全因再入院率和30天内相同主诊断再入院率分别下降0.06个百分点(P=0.031)、0.15个百分点(P=0.001)、0.47个百分点(P<0.001)、0.72个百分点(P<0.001)。结论尚无证据表明该市DIP改革后医疗服务质量受到负向影响,按病种付费试点城市需密切监测改革后医疗服务质量的变化。Objective To analyze the change of healthcare quality after the Diagnosis-Intervention Packet(DIP)payment system reform and provide evidence for improving payment system reform in China.Methods It collected discharge records of hospitalized patients with employee basic medical insurance scheme in first DIP pilot hospitals of a city from July 2017 to June 2021.It included three death-related measures and two readmission-related measures,which were all risk-adjusted considering the patient mix.It used t test to compare their differences before and after the DIP reform in July 2019.Results After the risk-adjustment,mortality rate of surgical patients,mortality rate of patients in low-risk DIP groups,all-cause readmission rate within 30 days after discharge and readmission rate with the same principal diagnosis within 30 days after discharge declined 0.06 percentage points(P=0.031),0.15 percentage points(P=0.001),0.47 percentage points(P<0.001)and 0.72 percentage points(P<0.001),respectively.Conclusion No current evidences indicated negative impacts of the DIP payment reform on the quality of healthcare in the city.Case-based payment pilot cities should closely monitor the change of healthcare quality after the reform.

关 键 词：医保支付方式 改革 按病种分值付费 医疗服务质量 

分 类 号：R197.1[医药卫生—卫生事业管理]