目的: 分析DIP支付方式“冲点”风险和宜昌市DIP改革“冲点”行为防控策略,为其他地区开展DIP支付方式改革提供治理思路。方法: 运用博弈论对DIP支付方式“冲点”风险进行分析,采用双重差分法对2018年—2022年宜昌市与湖北省非试点城市公立医院出院人次数变化情况进行比较,评价宜昌市DIP改革对公立医院“冲点”行为防控成效。结果: 博弈论模型显示DIP改革存在“冲点”风险,有效监管可以防范“冲点”行为。宜昌市公立医院出院人次数在DIP改革后与湖北省非试点城市公立医院相比不存在显著差异。结论: 宜昌市通过有效的智能监管机制和评价处罚机制一定程度遏制了“冲点”行为的产生,建议各地区在开展DIP支付方式改革过程中,应进一步关注并发挥智能监管机制和评价处罚机制的作用。

Objective: The paper analyzes the risk of "increasing related weight" in DIP payment methods and the prevention and control strategies for "increasing related weight" behavior in DIP reform of Yichang City, and provides governance ideas for developing DIP payment methods in other regions. Method: The game theory was used to analyze the risk of "increasing related weight" in the DIP payment method, and the difference-in-difference model was used to compare the changes in the number of inpatients in public hospitals between Yichang City and non-pilot cities in Hubei Province from 2018 to 2022, so as to evaluate the effectiveness of the DIP reform in Yichang City on the prevention and control of "increasing related weight" behavior in public hospitals. Result: The game theory model shows that there is a risk of "increasing related weight" in DIP reform, and effective supervision can prevent "increasing related weight" behavior. There is no significant difference in the number of inpatients between public hospitals in Yichang City and those in non-pilot cities in Hubei Province after the DIP reform. Conclusion: Yichang City has to some extent curbed the occurrence of "increasing related weight" behavior through effective intelligent supervision mechanism as well as evaluation and punishment mechanism. It is suggested that other regions should pay more attention to the role of intelligent supervision mechanism as well as evaluation and punishment mechanism in the process of DIP reform.