目的: 评估病组点数与绩效考核结果挂钩政策对医疗机构行为的影响。方法: 基于攀枝花市2018年1月—2024年12月参与DRG付费改革试点的各级医疗机构DT10病组“中耳炎及上呼吸道感染（<17岁）”月度结算数据,采用间断时间序列模型分析该政策实施前后医疗机构费用结构、平均住院日及自费比例等指标的变化。结果: 该政策在扣分指标方面显著降低了所有医疗机构的耗材费用占比。分级别分析显示,三级医院药品费用占比和耗材费用占比显著下降,平均住院日下降趋势得以维持;二级医院和基层医院的耗材费用占比显著降低。监测约束指标仅在基层医院中表现为医疗服务费用占比上升,其余指标未见显著变化。结论: 病组点数与绩效考核结果挂钩政策在管理耗材费用的支出方面发挥了作用,但监测约束类指标的激励效果有限,没有改变医疗机构的行为。建议医保支付方式改革建立“激励相容”的机制,加强与药品耗材集采及医疗服务价格政策的协同,并根据医疗机构功能定位实施差异化考核与激励,最终转向按健康结果评估与支付的价值医疗。
Abstract
Objective: The paper evaluates the impact of linking DRG points with performance evaluation results on healthcare provider behavior. Methods: An interrupted time series analysis (ITSA) was conducted using monthly settlement data from January 2018 to December 2024 for all medical institutions in Panzhihua City participating in the DRG payment reform pilot, focusing on DT10 disease group (otitis media and upper respiratory infection, patients aged under 17). Results: The policy significantly reduced the proportion of medical consumables expenses among all hospitals for penalty-related indicators. Analysis by hospital level indicated that, the proportion of drug and medical consumables expenses declined in tertiary hospitals, while the downward trend in average length of stay was maintained. In secondary and primary hospitals, the proportion of medical consumables expenses declined significantly. Monitoring and constraint indicators were associated only with an increase in the proportion of medical service expenditures in primary hospitals. Conclusions: The policy linking DRG points with performance evaluation results contributed to managing medical consumables expenditures, whereas monitoring and constraint indicators demonstrated limited incentive effects and failed to induce substantial behavioral changes among medical institutions. DRG payment method reforms should prioritize incentive-compatible mechanisms, strengthen coordination with national volume-based procurement (VBP) and medical service pricing policies, and adopt differentiated performance assessmentand motivation mechanisms aligned with hospital functional roles. In the longer term, payment systems may consider a transition toward a value-based model that assessment and payment are linked to health outcomes.
关键词
病组点数 /
绩效考核 /
医疗行为
Key words
DRG points /
performance evaluation /
healthcare provider behavior
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参考文献
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基金
国家社科基金重大项目“积极老龄化的公共选择”（17ZDA121）; 深圳人文社会科学重点研究基地：深圳国际研究生院社会治理与创新研究中心成果
