基于点的DRG支付系统对医疗保健资源利用和医疗服务提供者的行为的影响:在中国开展的一项试点准实验性研究
Xiao Huang1,2, Jinyun Zhu3, Jinghua Zhang1,4
1School of Business, Macau University of Science and Technology, Macau, Macau SAR, China.
Frontiers in public health
|October 23, 2025
概括
中国中国中国中国.
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
- 住院护理管理 住院护理管理
背景情况:
- 发展中国家在诊断相关集团 (DRG) 支付系统中面临预算和成本会计障碍.
- 中国的试点DRG点支付系统 (DRG-PBPS) 整合了全球预算和基于案例的支付.
- 本研究评估了DRG-PBPS对住院患者资源使用和提供者行为的影响.
研究的目的:
- 评估中国DRG-PBPS改革对住院患者资源利用的影响.
- 在DRG-PBPS下检查医疗保健提供者的潜在战略行为.
- 为发展中国家确定DRG-PBPS的可行性.
主要方法:
- 利用了来自15744例脑梗塞住院病例记录 (2018-2022) 的行政数据.
- 采用差异差异 (DID) 方法来分析住院费用和住院时间.
- 评估CCI分数和再接收率的变化,以检测患者的选择或过早出院.
主要成果:
- 实施DRG-PBPS导致住院费用下降9.7%,住院时间减少6.5%.
- 在CCI或14/90天的再接收率没有显著变化;在30天的再接收率下降了2.0%.
- 在所有灵敏度分析中,研究结果都很强大,在不同医院级别中一致.
结论:
- DRG-PBPS有效地减少了住院患者的资源利用,而没有不利的提供者行动.
- 中国的DRG-PBPS为付费服务模式提供了一个可行的替代方案.
- DRG-PBPS为预算限制的发展中国家提供了一个可行的战略.
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