DIP付费扩展对省内异地医保患者医疗费用的影响——基于某心血管三甲专科医院的数据  

The impact of DIP payment expansion on medical expenses for patients with inter-provincial medical insurance:Based on data from a teriary cardiovascular specialist hospital

作　　者：李慧 李亚洁 刘晓萍 LI Hui;LI Ya-jie;LIU Xiao-ping(School of Labor Economics,Capital University of Economics and Business,Beijing 100070,China;Fuwai Shenzhen Hospital,Chinese Academy of Medical Sciences,Shenzhen Guangdong 518057,China)

机构地区：[1]首都经济贸易大学劳动经济学院,北京100070 [2]中国医学科学院阜外医院深圳医院,广东深圳518057

出　　处：《中国卫生政策研究》2025年第1期34-42,共9页Chinese Journal of Health Policy

基　　金：国家社会科学基金青年项目(20CGL040);北京市教委社科一般项目(SM202010038010)。

摘　　要：目的:评估省内异地医保患者纳入按病种分值(DIP)付费管理对患者医疗费用的影响,为政策推进提供参考。方法:基于某心血管三甲专科医院数据,采取双重差分法对患者医疗费用、费用结构,以及病人负担进行分析。结果:DIP付费扩展对患者医疗费用以及费用结构中的床位费用、药品费用等四项费用未产生显著影响,对医务服务费用产生显著的促进作用,对检验检查费用和个人负担费用产生显著的抑制作用。结论:DIP付费扩展未控制医疗总费用,但提高了医务人员劳动价值,减少了以开具大检查的过度医疗方式获取利润的倾向,同时降低了患者负担。其他医疗机构应提前控制非政策目标患者费用,减轻改革压力。加快推进医保基金省级统筹对于将省内异地医保患者纳入DIP付费管理意义重大。Objective:To assess the impact of including intra-provincial medical insurance patients on medical expenses under the Diagnosis-Intervention Packet(DIP)payment management,and to provide a reference for promoting the policy in other provinces.Methods:Using data from a tertiary cardiovascular specialist hospital,the Difference-in-Difference method was applied to analyse medical expenses,cost structure,and patient burden.Results:The DIP payment extension had no significant effect on medical expenses or specific cost components,such as bed costs and drug costs.However,it significantly increased medical services costs while reducing checkups,examinations,and personal burden costs.Conclusions:While the DIP payment expansion has not controlled the total cost of care,it has increased the value of medical personnel's labour,reduced profit-driven tendencies for excessive testing,and reduced patients'burden.Other medical institutions should proactively control non-policy-targeted patient costs to reduce reform pressures.Accelerating the provincial co-ordination of medical insurance funds is critical for incorporating intra-provincial medical insurance patients into DIP payment management.

关 键 词：DIP付费 医保患者 双重差分法 医疗费用 

分 类 号：R197[医药卫生—卫生事业管理]