目的:评估DRG支付方式改革对职工医保基金支出的影响,为缓解基金平衡压力提供经验证据。方法:基于2015—2023年我国282个地级市的面板数据,采用多期双重差分法,结合平行趋势检验、安慰剂检验、PSM-DID、Bacon分解及CSDID等多种稳健性检验方法,系统分析DRG改革对医保基金支出的影响。结果:DRG改革显著提高了职工医保基金的支出水平,这一反“费用管理”直觉的发现提示改革初期存在医疗需求释放与制度适应成本;每千人卫生技术人员数对基金支出有显著正向影响,而每千人床位数影响不显著,表明人力资源比物质资源更具政策敏感性;改革效应在东部地区和中心城市更为突出,中西部地区和非中心城市效应不显著。结论:DRG改革在改善医保基金运行绩效的同时,其短期支出扩张效应需引起警惕。建议构建收支联动的动态调整机制、实施区域差异化策略、强化卫生人力资源优先导向,以促进医保基金长期可持续平衡。
Abstract
Objective:The paper attempts to evaluate the impact of the DRG payment reform on the expenditure of the employees’ medical insurance fund, and to provide empirical evidence for alleviating the pressure on the balance of the fund. Methods:Based on the panel data of 282 prefecture-level cities in China from 2015 to 2023, a multi-period difference-in-differences (DID) method was adopted, combined with parallel trend tests, placebo tests, PSM-DID, Bacon decomposition, CSDID and other multi-dimensional robustness tests to systematically analyze the impact of DRG reform on the expenditure of the medical insurance fund. Results:DRG reform significantly affected the expenditure levels of the employees’ medical insurance fund—a finding contrary to the intuition of cost containment —suggesting the release of medical demand and institutional adaptation costs during the early phase of the reform. The number of health technicians per thousand people had a significant positive impact on the fund's expenditure, while the number of hospital beds per thousand people had no significant effect, indicating that human resources are more policy-sensitive than material resources. The reform effect was more prominent in eastern regions and central cities, while the effect in central and western regions and non-central cities was not obvious. Conclusion:DRG reform has improved the operational performance of the medical insurance fund, but the short-term expenditure expansion effect of this reform needs to be taken seriously. A linkage mechanism for fund income and expenditure should be established, regional differentiated strategies should be implemented, and a reform orientation prioritizing human resources should be established to ensure the sustainability of the medical insurance fund.
关键词
DRG /
医保支付方式改革 /
多期DID /
职工医保基金
Key words
DRG /
medical insurance payment method reform /
multiple-period DID /
employees’ medical insurance fund
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