在诊断干预包改革下,肺癌住院护理的成本转移:中国的一项试点研究
Huawei Tan1, Xueyu Zhang1, Dandan Guo1
1School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
Risk management and healthcare policy
|March 10, 2025
概括
中国的诊断干预包 (DIP) 改革降低了肺癌住院费用,但转移了开支. 成本从C类转移到B类共同支付,需要针对不同医院和不同患者群体量身定制的政策.
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
- 在瘤学瘤学.
背景情况:
- 中国实施了诊断干预包 (DIP),这是一个区域全球预算下的基于案例的支付系统.
- 这一改革旨在控制各种疾病的住院服务成本.
研究的目的:
- 为了调查DIP改革后肺癌住院护理的成本转移行为.
- 分析DIP改革对医疗保健支出和患者自付费用的财务影响.
主要方法:
- 利用双重机器学习 (DML) 来分析国家试点城市Zunyi的数据.
- 对三级医院的肺癌住院患者的总医疗支出 (THS),不包括补偿的个人支付 (IPER) 和不同类别 (B和C) 的共同支付的变化进行了审查.
主要成果:
- DIP改革导致每例肺癌住院患者的总医疗支出大幅减少.
- 观察到个人支付显著增加,不包括退款和B类附加支付,C类附加支付下降.
- 根据医院的特点和患者保险分类,发现了成本控制和成本转移效应的显著差异.
结论:
- DIP改革有效地降低了肺癌的整体住院费用,但导致了支出转移.
- 成本转移主要是由于共同付款从C类重新分配到B类.
- 建议制定差异化的监管政策,以优化DIP改革在不同医疗机构和患者群体的有效性.
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