一个新的基于案例的支付系统对护理质量的影响:中国的差异分析
Xinyu Zhang1,2, Mengcen Qian1,3, Jiaqi Yan1
1School of Public Health, Fudan University, Shanghai, People's Republic of China.
Risk management and healthcare policy
|December 16, 2024
概括
中国的诊断干预包 (DIP) 支付改革通过减少患者再入院改善了医疗保健质量. 这种基于案例的支付系统显示出积极的影响,特别是减少了30天的再接收.
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
- 提高质量 提高质量
背景情况:
- 中国推出了一种基于个案的细粒度支付系统,称为诊断干预包 (DIP) 支付.
- 该DIP支付系统旨在标准化医疗保健成本并提高效率.
研究的目的:
- 评估DIP支付对中国主要城市医疗保健质量的影响.
- 探索推动DIP实施后护理质量变化的机制.
主要方法:
- 使用差异差异方法,分析了2017年7月至2021年6月的排放记录.
- 对比了13家试点医院和27家非试点医院在2019年7月1日之前和之后的死亡率,再接收和患者安全措施.
- 使用了5%的随机样本,其中包括122,637份排放记录.
主要成果:
- 在试点医院观察到30天所有原因的再入院率 (3.2pp) 和相同诊断的再入院率 (1.8pp) 的显著降低.
- 在住院死亡率,手术患者死亡率或与手术相关的并发症方面没有发现显著变化.
- 质量改善在三级医院最为突出,随着时间的推移和更高的护理强度而加剧.
结论:
- 诊断干预包 (DIP) 支付改革,医院级上限,与改善医疗保健质量有关,特别是减少再入院.
- 增加护理的强度,特别是对于严重的患者,可能是导致观察到的质量改善的一个因素.
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