摘要
目的:分析总额控制下按病种分值付费(DIP)政策对心血管病种患者负担、费用结构及住院天数的影响,评价该医保支付方式实施效果并提出相关建议。方法:首先利用事件研究法进行平行趋势检验,而后通过双重差分模型,分析两种不同医保(成都市医保、异地医保)付费方式对心血管病种住院患者及医院的影响。结果:该政策实施后,成都市医保心血管病种住院患者次均费用下降了21.32%,检查费、耗材费、反映医务人员劳动价值的费用也均有不同程度的下降,此外,成都市医保患者住院天数相比于异地医保患者缩短了14.23%(P<0.05),实际补偿比与药品费变化不大,患者费用结构并未得到优化,医院服务效率得以提升。结论:总额控制下按病种分值付费政策有助于降低心血管病种住院患者费用负担、缩减住院天数,对医院提升运行效率、实现高质量发展有积极影响,但总体费用结构仍待优化,政府应当“以价值为导向”,发挥医保支付方式的杠杆作用,引导医疗市场向高质量发展。
Objective To analyze the impact of the Diagnosis-Intervention Packet(DIP)policy on the burden of patients with cardiovascular diseases,cost structure,and hospitalization days,evaluate the effect of this health insurance payment method,and put forward relevant recommendations.Methods Firstly,the parallel trend test was carried out by using the event study method,and then the difference in differences model was used to analyze the effects of two different health insurance(Chengdu City health insurance and other health insurances)payment methods on the inpatients of cardiovascular diseases and hospitals.Results After the implementation of this policy,the average cost of hospitalized patients with cardiovascular diseases under the Chengdu Municipal Health Insurance has decreased by 21.32%,and the cost of examination,consumables,and costs reflecting the value of labor of medical personnel have also decreased to different degrees.In addition,the number of hospitalization days for patients with the Chengdu Municipal Health Insurance has been shortened by 14.23%compared to patients with medical insurance in a different place.(P<0.05),while the actual compensation ratio and cost of medicines did not change much,the patient's cost structure was not optimized,and the efficiency of hospital service can be improved.Conclusion The policy of paying according to disease group value under overall control can help reduce the cost burden of hospitalized patients with cardiovascular diseases,reduce the number of hospital days,and have a positive impact on improving hospital operational efficiency and achieving high-quality development.However,the overall cost structure still needs to be optimized.The government should follow the"value oriented"idea,play the leverage of medical insurance payment methods,and guide the medical market towards high-quality development.
作者
吴妮
周晓媛
王泺
伍利香
田明政
Wu Ni(West China School of Public Health,West China Fourth Hospital,Sichuan University,Chengdu,P.R.China)
出处
《中国卫生事业管理》
北大核心
2024年第4期380-383,448,共5页
Chinese Health Service Management
基金
科技部国家重点研发计划“健康管理综合服务应用示范”(2020YFC2006500)
四川省软科学研究计划项目“老龄化对城镇职工医保基金利用的影响及变化规律研究”(2015ZR0209)。
作者简介
第一作者:吴妮,硕士研究生;通讯作者:周晓媛,博士,硕士生导师,副教授,zhouxyuan@scu.edu.cn。
