基于间断时间序列分析的省内异地就医纳入DRG付费实证研究  

An Empirical Study of DRG Payment for Cross-Region Healthcare Patients Within the Province Based on Interrupted Time Series Analysis

作　　者：王奉香 徐彤 亓文婷 王孝勇 

机构地区：[1]山东第一医科大学附属省立医院,济南250021 [2]国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学),济南250012 [3]山东大学卫生管理与政策研究中心(山东省重点新型智库),济南250012

出　　处：《中国医疗保险》2025年第3期68-73,共6页China Health Insurance

摘　　要：目的:分析DRG付费对省内异地就医患者住院费用的影响,为深化异地就医支付方式改革提供实证依据。方法:本研究以山东省某三甲公立医院为研究对象,收集该院2022年至2024年期间省内异地就医医保住院患者的相关数据。采用描述性统计分析、非参数秩和检验及间断时间序列模型等方法,评估DRG付费制度实施前后,异地就医患者住院费用的变化情况,并探讨DRG付费制度与国家药品集中带量采购(以下简称集采)政策在控制药品费用方面的协同效应。结果:实施DRG付费改革后,该院省内异地就医患者的次均住院费用、次均个人负担费用和次均统筹基金支付费用均呈下降趋势,住院费用结构得到优化,但是长期趋势性变化尚不明显。此外,DRG付费与集采政策在降低药品费用方面展现出协同效应,次均药品费用累计降幅达25.51%。结论:省内异地就医纳入本地DRG付费体系已取得初步成效,但仍需制定更加科学合理的付费标准、深入探索并优化DRG基础病组的分类与定价机制、建立多方参与的协商沟通机制及强化政策协同效应,以持续推进异地就医医保支付方式改革。Objective:The paper analyzes the impact of DRG payment on hospitalization costs of cross-region patients within the province,in order to provide empirical evidence for reforming payment methods of cross-region healthcare.Methods:The data of cross-region inpatients in a grade-A tertiary hospital in Shandong Province from 2022 to 2024 was collected.Descriptive statistical analysis,nonparametric rank sum test and interrupted time series model were used to analyze the changes of hospitalization costs of cross-region patients within the province before and after the implementation of DRG payment,and explore the synergy effect between DRG payment and the policy of centralized drug procurement in controlling drug costs.Results:After the implementation of the DRG payment reform,all the average hospitalization costs,the average personal burden costs and the average pooling fund expenses of the cross-region patients within the province have decreased,and the hospitalization cost structure has been optimized,but the long-term trend change is not obvious.Meanwhile,DRG payment and centralized drug procurement policies have synergy effect on reducing drug costs,with a cumulative decrease of 25.51%in the average drug costs.Conclusion:The reform of DRG payment for cross-region healthcare has achieved encouraging results,we need to establish a more scientific and rational payment standard,deeply investigate and optimize the classification and pricing mechanism of DRG basic disease groups,establish a multi-stakeholder consultation and communication mechanism and strengthen policy synergy effect to further promote the reform of medical insurance payment for cross-site healthcare.

关 键 词：异地就医 DRG付费 药品集采政策 间断时间序列分析 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]