目的: 通过深入分析某省级三甲医院在实施DIP支付政策前后的脑卒中患者住院费用变化,为进一步完善医保支付政策提供实证依据。方法 采用中断时间序列方法分析DIP政策对不同类型脑卒中患者次均住院费用和分项费用的影响。结果: 研究发现,实施DIP支付政策不仅显著降低了脑卒中患者的次均住院费用（454.80元/月,P=0.012）,而且对于不同年龄组、合并症/并发症情况与住院天数等患者的住院费用均产生了积极影响。其中,受DIP政策干预影响,多数类型患者的治疗费和药费都出现了持续下降。结论: DIP支付改革对脑卒中住院患者的医疗费用整体影响显著,但不同类型患者的费用变化趋势存在较大差异。建议医疗机构主动强化DIP支付政策认知,深化大数据管理模式的应用,全面加强患者健康管理,以期进一步优化和巩固DIP支付政策成效。
Abstract
Objective: This study aims to provide empirical evidence for further refining the medical insurance payment policy by conducting an in-depth analysis of the changes in hospitalization expenses for stroke patients before and after the implementation of the DIP payment policy in a provincial first-class hospital. Methods: The interrupted time series analysis method was employed to investigate the influence of the DIP policy on the average hospitalization cost per admission and component cost for different types of stroke patients. Results: The study found that the implementation of the DIP payment policy not only significantly reduced the average hospitalization expenses per admission for stroke patients (by 454.80 yuan/month, P=0.012), but also had a positive impact on hospitalization expenses across different age groups, with or without complications/comorbidities, and length of stays. Specifically, under the influence of the DIP policy, the treatment and medication costs for most types of patients showed a continuous decline. Conclusions: The DIP payment reform had a significant overall impact on the medical expenses of stroke inpatients, but there were significant differences in the trends of cost change among different types of patients. It is recommended that medical institutions actively strengthen their understanding of the DIP payment policy, deepen the application of big data management models, and comprehensively enhance patient health management, in order to further optimize and consolidate the effectiveness of the DIP payment policy.
关键词
中断时间序列 /
DIP /
脑卒中 /
住院费用
Key words
interrupted time series /
DIP /
stroke /
hospitalization costs
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基金
安徽医科大学医院管理研究所“国医科技”开放项目“医保系统与国家区域医疗中心协同治理机制研究”（2024gykjgx08）; 安徽省高校哲学社会科学研究项目“DIP付费下核心利益相关者的博弈分析与实证研究”（2023AH051736）
