目的:基于真实世界数据,分析DRG支付方式改革对典型冠脉介入耗材（冠脉支架与药物涂层球囊）使用及费用的影响,为完善医保支付方式改革与耗材治理提供参考。方法:采集S市27家DRG第一、二批试点医院2020—2022年179867例冠心病住院患者的医保结算数据。运用描述分析及带对照组的中断时间序列分析（ITS）方法,比较分析DRG改革对典型耗材次均使用量、费用及使用率的影响,进一步分析不同类型支架次均使用量及费用的变化。结果:DRG改革后,全体冠心病患者次均支架使用量与费用显著下降,次均球囊使用量与费用显著上升;ITS分析显示,支架使用量和使用率由集采后的高位运行转为缓慢下降,费用亦长期下行;球囊使用量和使用率在支架集采后快速增长的势头被有效扭转,长期趋稳;植入支架患者亚组中,集采中选支架使用量保持集采后的高位稳定,费用维持低位稳定;未中选支架使用量与费用稳定在集采后的较低水平;集采范围外支架使用量和费用呈趋势性收敛。结论:DRG改革有效约束了支架使用量与费用的扩张,并与集采政策互补协同,形成集采降价、DRG控总量和约束费用的联动格局;同时扭转了球囊使用量和费用的过快增长,使其呈现量稳费降。DRG改革推动冠脉介入耗材从规模扩张向理性约束与价值导向转变,顺应当前“介入无植入”的临床趋势,在引导医疗服务行为更趋理性、促进资源合理配置中发挥积极作用。
Abstract
Objective:Using real-world data, the paper examines the impact of diagnosis-related groups (DRG) payment reform on the utilization and costs of typical coronary interventional consumables (coronary stents and drug-coated balloons (DCB)), providing evidence for improving payment reform and consumables governance. Methods:Medical insurance settlement data of 179867 inpatient cases with coronary heart disease were collected from 27 DRG pilot hospitals (first and second batches) in City S from 2020 to 2022. Descriptive analysis and interrupted time series (ITS) analysis with a control group were applied to evaluate the effects of DRG reform on average quantity and cost per case, and utilization rate of the typical consumables. Further analyses of changes in average quantity and cost per case were conducted for different categories of stents. Results:After DRG reform, among all inpatients, average quantity and cost of stents per case decreased significantly, whereas the average quantity and cost of DCB per case increased significantly. ITS analysis indicated that, following DRG reform, stent quantity and utilization rate shifted from a post-volume-based procurement (VBP) high plateau to gradual decline, with sustained cost reduction. The rapid post-VBP growth of DCB quantity and utilization rate was curbed, achieving long-term stabilization. In the subgroup of patients undergoing stent implantation, selected products maintained high utilization at low cost, Non-selected products stabilized at persistently low utilization and cost levels following VBP implementation. Utilization and costs of out-of-scope stents exhibited a sustained convergent decline. Conclusion:DRG reform effectively constrained the expansion of stent utilization and costs, and complemented the VBP policy to form a coordinated pattern: VBP reduces prices, while DRG controls total volume and contains costs. It also reversed excessive DCB growth toward a pattern of stable volume with reduced costs. Overall, DRG reform promotes a shift from scale-driven to rational and value-oriented use of consumables, aligns with the clinical trend of “leave-nothing-behind”, and advances rational medical behavior and efficient resource allocation.
关键词
支付方式改革 /
疾病诊断相关分组 /
医用耗材 /
中断时间序列分析
Key words
payment method reform /
diagnosis-related groups /
medical consumables /
interrupted time series analysis
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