按病种分值付费实施前后广东省某三甲医院脑梗死患者住院费用分析  

Analysis of hospitalization expenses of patients with cerebral infarction in a tertiary hospital in Guangdong province before and after the implementation of diagnosis⁃intervention package

作　　者：罗敏[1,2] 李小峰[2] 黄铿 林爱华[1] LUO Min;LI Xiaofeng;HUANG Keng;LIN Aihua(School of Public Health,Sun Yat-sen University,Guangzhou,Guangdong 510080,China;Department for Smart Hospital Design and Development,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou,Guangdong,510120,China)

机构地区：[1]中山大学公共卫生学院,广东广州510080 [2]中山大学孙逸仙纪念医院智慧医院建设部,广东广州510120

出　　处：《热带医学杂志》2024年第12期1767-1772,共6页Journal of Tropical Medicine

基　　金：国家自然科学基金(72074229);逸仙管理研究项目(GL2315,GL1904)。

摘　　要：目的分析按病种分值付费(DIP)实施前后,广东省某三甲医院脑梗死患者住院费用的变化情况,为推进医保支付方式改革和优化疾病管控提供数据支撑和意见建议。方法以2013年1月1日-2022年12月31日广东省某三甲医院脑梗死住院患者12434例为研究对象,该医院自2017年7月1日起实施DIP,故2013年1月1日-2017年6月30日为DIP实施前(n=5341),2017年7月1日-2022年12月31日为DIP实施后(n=7093);通过倾向性评分匹配和中断时间序列分析方法,对DIP实施前后的住院费用进行深入比较。结果与DIP实施前比较,DIP实施后脑梗死患者次均住院总费用有所降低(Z=-3.538,P<0.001);手术患者显著增加(χ^(2)=1113.046,P<0.001),同时急、疑难、危重患者明显增多(χ^(2)=1726.375,P<0.001),次均住院总费用呈现出上升的持续效应趋势(t=2.099,P=0.038),差异均有统计学意义。住院各项费用中,与DIP实施前比较,DIP实施后综合医疗服务费、诊断费、治疗费、耗材费有所上升,药品费明显下降,差异均有统计学意义(Z=27.300、7.402、16.951、58.875、-18.719,P均<0.001);康复费差异无统计学意义(Z=1.515,P=0.130),但呈现上升的持续效应趋势(t=3.942,P<0.001)。结论DIP实施对降低脑梗死患者次均住院总费用影响明显,DIP实施对脑梗死患者住院费用内部结构有改善,但仍存在优化空间。Objective To analyze the changes in hospitalization costs of cerebral infarction patients in a tertiary hospital in Guangdong province before and after the implementation of diagnosis⁃intervention package(DIP),and provide data for promoting the reform of medical insurance payment methods and optimizing disease control.Methods A total of 12434 inpatients with cerebral infarction in a tertiary hospital in Guangdong province from January 1,2013 to December 31,2022 were selected as the research subjects.The hospital implemented DIP since July 1,2017,so January 1,2013⁃June 30,2017 was before DIP implementation(n=5341),July 1,2017⁃December 31,2022 was after DIP implementation(n=7093);through propensity score matching and interrupted time series analysis method was used to conduct an in⁃depth comparison of hospitalization costs before and after the implementation of DIP.Results Compared with before DIP implementation,the average hospitalization costs for patients with cerebral infarction decreased after DIP implementation(Z=-3.538,P<0.001);the number of surgical patients increased significantly(χ^(2)=1113.046,P<0.001),and the number of emergency,difficult and critically ill patients increased significantly(χ^(2)=1726.375,P<0.001),and the average hospitalization costs showed a continuous upward trend(t=2.099,P=0.038),and the differences were statistically significant.Among various hospitalization expenses,compared with before DIP implementation,comprehensive medical service fees,diagnosis fees,treatment fees,and consumables fees increased after DIP implementation,while drug fees dropped significantly,and the differences were statistically significant(Z=27.300,7.402,16.951,58.875,-18.719;all P<0.001);no significant difference was found in rehabilitation fees(Z=1.515,P=0.130),but there was a sustained effect of increase(t=3.942,P<0.001).Conclusions The impact of reducing the average hospitalization costs of patients with cerebral infarction was obvious.The implementation of DIP had improved the internal structure

关 键 词：按病种分值付费 脑梗死 倾向性评分匹配 中断时间序列 

分 类 号：R743.3[医药卫生—神经病学与精神病学]