DIP改革对医疗机构费用和患者就医流向的影响分析——以Y市急性阑尾炎为例  

Analysis of the Impact of DIP Reform on the Cost of Health Care Institutions and the Flow of Patient Care Sampled with Acute Appendicitis in Y City

作　　者：徐一心 林坤河[1] 张雨孟 彭馨晔 项莉[1,3] Xu Yixin(School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,P.R.China)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,湖北武汉430000 [2]武汉大学中南医院 [3]国家医疗保障研究院华科基地

出　　处：《中国卫生事业管理》2024年第11期1239-1242,共4页Chinese Health Service Management

基　　金：国家自然科学基金项目“竞合视角下区域点数法总额预算对县域价值医疗服务体系激励机制研究”(72174068);中央高校基本科研业务费专项资金资助“价值视角下DIP执行模式及激励效应研究”(YCJJ20242228)。

摘　　要：目的:本文通过研究Y市DIP改革前后急性阑尾炎患者住院相关数据的变化,分析DIP改革对医疗费用和患者流向的影响。方法:收集Y市2021年1月至2022年12月住院患者结算数据,对住院费用、平均住院天数、各等级医疗机构人次占比的年度数据做描述性分析,对月度数据做间断时间序列分析。结果:Y市开展DIP改革,将急性阑尾炎纳入基层病种,实施“同城同病同价”。改革后患者住院费用呈明显下降趋势,次均住院费降幅达20.7%、次均自付费用降幅达23.6%、自付费用占比下降了1.49%;平均住院日下降趋势有所减缓,但整体仍下降了0.01天;一级医疗机构治疗人次占比明显上升,从2021年16.94%增加至2022年30.06%,三级医院明显减少,从2021年27.41%降低至2022年15.42%。结论:DIP改革可以推动医疗机构控制费用、提升效率,促进落实分级诊疗。建议进一步完善医保支付的配套政策,充分体现医疗服务价值;加强各级医疗机构服务水平建设,增加患者对基层医疗机构的信任感。Objective To analyze the impact of DIP reform on medical expenses and patient flow.Methods The settlement data of inpatients in Y City from January 2021 to December 2022 were collected.Descriptive analysis was made on the annual data of hospitalization cost,average length of stay,and the proportion of visits in medical institutions of different levels,and discontinuous time series analysis was made on the monthly data.Results Y city carried out DIP reform,including acute appendicitis into the basic diseases,and implemented"the same disease in the same city and the same price".After the reform,the inpatient expenses showed an obvious downward trend,the average inpatient expenses decreased by 20.7%,the average out-of-pocket expenses decreased by 23.6%,and the proportion of out-of-pocket expenses decreased by 1.49%.The average length of stay in hospi-tal decreased somewhat,but the overall length still decreased by O.O1 days.The proportion of treatment visits in primary medical institutions increased significantly,from 16.94%in 2021 to 30.06%in 2022,while tertiary hospitals decreased significantly,from 27.41%in 2021 to 15.42%in 2022.Conclusion DIP reform can promote medical institutions to control costs,improve effi-ciency,and implement the hierarchical diagnosis and treatment.It is suggested to further perfect the supporting policies of medical insurance payouts,embody the value of medical services,strengthen the construction of medical services of medical institutions,and improve the patients'trust on grassroots medical institutions.

关 键 词：按病种分值付费 急性阑尾炎 医疗费用 服务效率 就医流向 

分 类 号：R197.3[医药卫生—卫生事业管理]