医院对中国新的基于病例的支付系统的反应:患者选择效应
Xinyu Zhang1,2, Shenglan Tang2,3,4, Ruixin Wang1
1School of Public Health, Fudan University, 130 Dong'an Road, Shanghai 200030, China.
Health policy and planning
|April 6, 2024
概括
中国的诊断干预包 (DIP) 支付改革导致医院接收更生病的患者,并增加动脉样性心脏病的治疗强度. 政策制定者必须平衡成本控制与潜在的意外后果.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 医疗支付系统 医疗支付系统
背景情况:
- 中国实施了诊断干预包 (DIP) 支付系统,这是全球预算前性支付的一种形式,根据诊断和程序对患者进行分类.
- 了解提供者对支付改革的反应对于有效的医疗保健政策和成本控制至关重要.
研究的目的:
- 评估中国DIP支付改革对全关节整形术 (THA/TKA) 和动脉样性心脏病 (AHD) 的医院患者选择和治疗强度的影响.
主要方法:
- 使用差异差异方法来比较患者特征的变化 (年龄,查尔森并发症指数 (CCI) 严重程度) 和治疗强度 (相对重量 (RW)) 在DIP改革 (2019年7月) 之前和之后.
- 该研究分析了2017年7月至2021年6月在中国一座大城市的数据,将DIP试点地区的医院与非试点地区的医院进行了比较.
主要成果:
- 与非DIP医院相比,DIP改革下的医院接收了THA/TKA严重程度增加的患者.
- 在改革后,AHD患者的治疗强度 (RW) 在DIP医院 (5.5%) 比非DIP医院显著增加.
- 患者年龄趋势在两种疾病的DIP和非DIP医院中都相似;非DIP医院的AHD患者严重程度下降.
结论:
- DIP支付改革促使医院接收更生病的患者,并加强对AHD的治疗,这表明与成本控制目标一起有意想不到的后果.
- 决策者应该仔细考虑未来支付系统的好处与潜在不利影响之间的平衡.
- DIP支付模式可以为其他国家的替代支付系统提供见解.
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