DRG/DIP医保支付方式改革对医保基金的影响——基于PSM-DID方法的实证研究  

The Effect of DRG/DIP Payment Reform on Medical Insurance Fund:An Empirical Study Based on PSM-DID

作　　者：于淼[1] 朱晓佳 YU Miao;ZHU Xiao-jia

机构地区：[1]清华大学医疗管理学院 [2]清华大学公共管理学院

出　　处：《保险研究》2025年第3期103-115,共13页Insurance Studies

基　　金：国家卫生健康委卫生发展研究中心委托课题“紧密型医共体医保总额付费和健康绩效评估研究”;清华大学笃实专项(2024Z11DSZ001);广州市哲学社科规划课题“广州健全多层次社会保障体系研究”(2023GZQN68)的资助。

摘　　要：本文利用2016~2022年全国城市级面板数据,将DRG/DIP医保支付方式改革作为政策冲击,研究了改革对城镇职工和城乡居民医保基金人均支出、支出增长率和基金结余率的影响。基于倾向值匹配后的多时点双重差分模型回归结果显示,DRG/DIP实际付费显著降低了职工医保基金人均支出,增加了基金结余率,抑制了居民医保基金人均支出增长率,即DRG/DIP医保支付方式改革有效控制了医保基金支出的过快增长,但这一效果在短期显著,在长期不显著。进一步研究发现,DRG付费改革的效果优于DIP付费,DRG/DIP医保支付方式改革的效果在高住院率地区更为明显。Utilizing national city-level panel data from 2016 to 2022 and considering the DRG/DIP payment reform as an exogenous shock,this study examines the influence of DRG/DIP payment reform on per capita expenditures,expenditure growth rate,and the balance rate of the social medical insurance funds for urban employees and urban and rural residents.The findings from the multi-period DID model,which is based on PSM,reveal that the implementation of DRG/DIP significantly decreases per capita expenditure and enhances the fund balance rate of the Urban Employee Basic Medical Insurance,and constraints the growth rate of per capita expenditure for the Urban-Rural Resident Basic Health Insurance.These outcomes suggest that the payment reform effectively mitigates the excessive growth of medical insurance fund expenditures.Nevertheless,this impact is pronounced in the short term but diminishes over the long term.Additional analysis indicates that DRG's effect surpasses that of DIP,and the influence of the payment reform is more pronounced in regions with elevated hospitalization rates.

关 键 词：医保基金 医保支付方式改革 DRG DIP 

分 类 号：F840.684[经济管理—保险]