我国DRG支付方式改革对住院时间及费用影响的meta分析  

Meta Analysis of Impact of DRG Payment Reform in China on Length of Stay and Cost

作　　者：伏欣 张华[2] 谢亚坤 邱子怡 金辉[1] FU Xin(Department of Epidemiology and Health Statistics,Key Laboratory of Environmental Medicine Engineering,Ministry of Education,School of Public Health,Southeast University,Nanjing,Jiangsu,210009,China)

机构地区：[1]东南大学公共卫生学院流行病与卫生统计学系,东南大学公共卫生学院教育部环境医学工程重点实验室,江苏南京210009 [2]东南大学公共卫生学院医疗保险系,江苏南京210009

出　　处：《医学与社会》2024年第4期74-80,共7页Medicine and Society

基　　金：国家自然科学基金资助项目,编号为81573258;新发传染病防治科技示范工程,编号为BE2015714、BE2017749;江苏省六大人才高峰,编号为WSN-002;江苏省医学重点学科,编号为ZDXKA2016008。

摘　　要：目的:通过meta分析探讨我国DRG支付方式改革对住院时间及费用的影响,为DRG支付方式改革的完善提供有益的参考和启示。方法:在Web of Science、PubMed、SCOPUS、知网、万方数据库中系统检索关于我国DRG支付方式改革对住院时间及费用影响效果的文献,根据纳入排除标准筛选提取数据,并使用Newcastle-Ottawa Scale(NOS量表)评估纳入研究的方法学质量。使用随机或固定效应模型计算Hedges'g效应,以评估住院时间和住院费用的结果。结果:共纳入14篇文献。根据meta分析结果,DRG的实施对患者住院费用的影响无统计学意义(Hedges'g<-0.001;95%CI:-0.03,0.02;P=0.85),对住院时间的影响具有统计学意义(Hedges'g=-0.23;95%CI:-0.39,-0.07;P=0.01)。影响因素有研究地区、医院级别、疾病类型、研究时长和方法。结论:DRG支付方式改革对缩短平均住院时间具有积极作用,对住院费用并无显著影响。应根据研究地区、疾病类型和医院等级等多方面原因具体分析,后续工作重点需要加强监管。由于纳入文献和实施政策在质量、疾病覆盖范围、支付政策的组成部分和其他细节方面存在差异,DRG的影响和长期效应需要更多研究来持续评估。Objective:To analyze the impact of China's DRG payment reform on hospital length of stay and costs through meta analysis,so as to provide useful references and insights for the improvement and refinement of DRG payment reform.Methods:A comprehensive database search was conducted on the Web of Science,PubMed,SCOPUS,China national knowledge infrastructure,and Wan Fang databases on the implementation effect of the DRG payment system.The Newcastle-Ottawa scale was used to assess the methodological quality of the included studies.Hedges'g effect sizes were calculated using a random or fixed-effects model to evaluate the outcomes of length of stay and hospitalization expenses in this study.Results:Fourteen articles were included in this analysis.According to the meta-analysis,there was no significant difference in hospitalization expenses between the two groups implementing DRG(Hedges'g<-0.001,95%CI:-0.03,0.02,P=0.85),and the difference in length of stay between the two groups was statistically significant(Hedges'g=-0.23,95%CI:-0.39,-0.07,P=0.01).The influencing factors were regional development,hospital level,disease department,research duration and method.Conclusion:The implementation of DRG in China does not significantly impact hospitalization expenses but does affect the reduction of average hospitalization duration.Specific strategies should be formulated based on various factors such as region,types of diseases,and the level of healthcare institutions.Subsequent efforts should focus on strengthening supervision and oversight.Given the variations in literature inclusion,policy implementation,quality,disease coverage,payment policies,and other details,continuous evaluation through further research is necessary to understand the sustained impact and long-term effects of DRG.

关 键 词：医保支付方式 DRG 住院费用 住院时间 

分 类 号：R-05[医药卫生]