DRG支付方式改革对中医医院住院费用及结构的影响  

Impact of DRG Payment Method Reform on Hospitalization Costs and Structures of Traditional Chinese Medicine Hospitals

作　　者：陈蒙恩 袁有树 王焱 侯浩佳 杨敬宇[4,5] 王志伟[2,6] Chen Meng'en;Yuan Youshu;Wang Yan;Wang Zhiwei(School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing,102400,China;School of Management,Beijing University of Chinese Medicine,Beijing,102400,China;不详)

机构地区：[1]北京中医药大学中医学院,北京102400 [2]北京中医药大学管理学院,北京102400 [3]甘肃中医药大学公共卫生学院,甘肃兰州730000 [4]甘肃中医药大学卫生管理学院,甘肃兰州730000 [5]兰州大学公共卫生学院,甘肃兰州730000 [6]北京中医药大学国家中医药发展与战略研究院,北京102400

出　　处：《中国卫生经济》2025年第3期18-24,共7页Chinese Health Economics

基　　金：国家中医药管理局资助项目(ZYZB-2023-435,GZY-FJS-2022-045)。

摘　　要：目的:分析DRG支付方式改革对中医医院住院费用及结构的影响。方法:使用2017—2022年甘肃省庆阳市与天水市公立中医医院住院患者费用数据,运用描述性统计和双组间断时间序列模型进行DRG支付方式改革前后对比分析。结果:DRG支付方式改革对二级中医医院的次均住院费用、中药类费用、西药类费用控制均未产生有效影响(P>0.05),但次均西药类费用占比改革后呈现明显下降趋势(β_(9)=-0.19,P<0.01);DRG支付方式改革使得三级中医医院的次均住院费用、中药类费用、西药类费用均转为明显下降趋势(P<0.05),同时二、三级中医医院次均中药类费用占比的下降趋势在改革后均被遏制。结论:DRG支付方式改革对三级中医医院的住院费用、中西药类费用控制有效,而对二级中医医院费用控制效果欠佳,可能利于增强中医药使用和提升中药类费用占比。中医DRG支付方式改革应强化费用监管,积极发挥中医药特色优势,并推进中医医院差异化改革。Objective:To analyze the impact of DRG payment method reform on hospitalization costs and structure in traditional Chinese medicine hospitals.Methods:Using the cost data of hospitalized patients from 2017 to 2022 for public traditional Chinese medicine hospitals in Qingyang and Tianshui,descriptive statistics and two groups interrupted time-series models were implemented to compare the changes before and after DRG payment method reform.Results:DRG payment method reform had no effective impact on the secondary traditional Chinese medicine hospital's average hospitalization costs,average Chinese medicine costs,and average western medicine costs(P>0.05),but the average proportion of western medicine costs showed an obvious downward trend after the reform(β_(9)=-0.19,P<0.01).DRG payment method reform resulted in tertiary traditional Chinese medicine hospitals turning to obvious decreasing trends in average hospitalization costs,average Chinese medicine costs,and average western medicine costs(P<0.05),while the pre-reform decreasing trends in the average proportion Chinese medicine costs share of both secondary and tertiary traditional Chinese medicine hospitals were curbed in the post-reform period.Conclusion:DRG payment method reform had effectively controlled hospitalization costs,Chinese medicine costs,and western medicine costs of tertiary traditional Chinese medicine hospitals,while the cost control of secondary traditional Chinese medicine hospitals has been ineffective,probably contributing to the enhancement of the use of Chinese medicine and the average proportion of Chinese medicine costs.DRG payment method reform for Chinese medicine should strengthen the supervision of costs,actively utilize the advantages of the characteristics of Chinese medicine,and promote the differentiated reform of traditional Chinese medicine hospitals.

关 键 词：疾病诊断相关分组 中医医院 住院费用 双组间断时间序列模型 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R197