目的: 分析中医类医疗服务价格项目立项指南落地实施对中医院住院诊疗行为的影响,为中医院更好地适应立项指南、优化医院资源配置提供参考。方法: 基于广州某三甲中医院2025年3—6月医保结算数据,以指南实施时间2025年4月为干预点,使用Stata绘制箱线图对病例数、实际结算分值、住院天数、中医介入数量、总费用进行对比分析。结果: 指南实施后,轻症病例重复性中医操作减少,住院诊疗服务趋于规范,重症和慢性消耗性病例资源投入显著上升,医疗费用结构呈现“轻症压缩、重症保障”的分化格局。结论: 中医类医疗服务价格项目立项指南落地有效抑制了轻症病例的过度诊疗,引导医院将更多资源投入重症复杂病例,促进了中医院住院诊疗服务供给的规范化,在优化费用结构、提升医保基金利用效率等方面发挥了积极作用。未来应结合更长期的观察数据比较临床结局指标,进一步评估指南落地后的系统性影响。
Abstract
Objective: The paper analyzes the impact of the implementation of approval guidelines for traditional Chinese medicine (TCM) medical service price on inpatient diagnosis and treatment behavior in TCM hospitals, providing a reference for better adapting to these guidelines and optimizing hospital resource allocation. Methods: Based on medical insurance settlement data from March to June, 2025 at a tertiary TCM hospital in Guangzhou City, with the guideline implementation in April 2025 as the intervention point, Stata was used to draw box plots for comparative analysis of the number of cases, actual settlement scores, length of hospital stay, number of surgical procedures, and total expenses. Results: After implementing the guidelines, repetitive procedures for mild cases decreased, inpatient diagnosis and treatment services became more standardized, and resource input for severe and chronic consumptive cases increased significantly. The structure of medical expenses showed a differentiated pattern of "fewer mild cases, more severe cases". Conclusion: The implementation of approval guidelines for TCM medical service price effectively curbed over-treatment of mild cases, guided hospitals to allocate more resources to severe and complex cases, and promoted the standardization of inpatient diagnosis and treatment services in TCM hospitals. It had a positive effect on optimizing the cost structure and improving the efficiency of medical insurance fund utilization. Future studies should incorporate long-term observational data to compare clinical outcome indicators and further assess the systemic impact after guideline implementation.
关键词
医疗服务价格项目 /
立项指南 /
中医院 /
诊疗行为
Key words
medical service price project /
approval guidelines /
traditional Chinese medicine hospital /
diagnosis and treatment behavior
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