诊断干预套餐支付改革对中国供应商行为的影响:一项受控中断时间序列研究
Ruixin Wang1, Jiaqi Yan1, Xinyu Zhang1
1School of Public Health, Fudan University, Shanghai, China.
International journal of health policy and management
|December 3, 2024
概括
中国的诊断干预包 (DIP) 改革将医院的重点从体积转移到患者病例重量. 医院增加了治疗强度,而不是诊断升级编码,以应对新的支付模式.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健支付模式 医疗保健支付模式
- 医疗保健服务研究 医疗服务研究
背景情况:
- 中国实施了一种新的诊断干预包 (DIP) 支付系统,以规范医疗保健提供者的行为.
- G城市在2018年在区域全球预算下从每次入学固定费率过渡到DIP.
- 这项研究评估了G市DIP改革后的提供者行为变化.
研究的目的:
- 检查DIP支付改革后医疗保健提供者行为的直接和趋势变化.
- 分析DIP对住院患者数量,病例组合复杂性和治疗强度的影响.
- 调查医院级别和疾病类别之间的差异性影响.
主要方法:
- 利用了G市320家医院的1000多万个住院出院记录 (2016-2019).
- 雇员控制中断时间序列 (ITS) 分析与无保险患者作为反事实控制.
- 评估了住院患者体积,平均DIP重量,平均诊断重量和平均治疗重量的变化.
主要成果:
- 改革后,观察到住院患者数量下降的趋势 (P=0.052) 和平均DIP体重增长的增加 (P=0.02).
- 平均诊断重量没有显著变化,但平均治疗重量趋势显著增加 (P=0.001).
- 二级和三级医院的体积减少,DIP重量/治疗强度增加;初级医院的体积减少,DIP重量稳定,诊断重量增加,治疗强度降低.
结论:
- DIP改革鼓励医院优先考虑患者病例的复杂性 (重量),而不是单纯的数量.
- 医院的反应主要是加强治疗,而不是进行诊断的升级编码.
- 由于DIP系统下的区域竞争,初级医院可能会遇到财务挑战.
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