Objective: The study used interrupted time series analysis to evaluate the impact of medical insurance fund intelligent supervision with denial-of-payment policy on hospital consumables payment type verification error rates, and to explore the policy's effects on standardized utilization of medical insurance fund for consumables and mitigation of moral hazard in hospital consumables management control. Methods: This study selected inpatient cost data for staplers and specialized wound covering materials from a Class-A tertiary public hospital in Wenzhou City, covering the period from January 2023 to November 2024. We employed the DW test and BG test to examine autocorrelation in the consumables payment type verification error rate, conducted the ADF test to assess data stationarity, and utilized the implementation date of the consumables intelligent supervision and denial-of-payment policy as the interruption point. A segmented regression model was applied to analyze changes in the consumables payment type mis-verification rate. Results: Post-implementation of the consumables intelligent supervision and denial-of-payment policy, long-term analysis showed the self-payment mis-verification rate for staplers increased by 0.51 percentage points per month, while the self-payment mis-verification rate for specialized wound covering materials increased by 0.28 percentage points monthly. Conversely, the medical insurance mis-verification rate for staplers decreased by 0.08 percentage points per month, and the medical insurance mis-verification rate for specialized wound covering materials decreased significantly by 3.95 percentage points monthly. Conclusions: While the consumables intelligent supervision and denial-of-payment policy exerts a positive influence on hospitals' accurate verification of consumable payment types and compliant utilization of medical insurance funds, it simultaneously increases hospitals' burden in consumables cost review and the financial risk of bearing denied payment costs. Furthermore, it may lead hospitals to approve reimbursable medical consumables as self-paid items, thereby shifting the financial risk onto patients. To optimize the intelligent supervision and denial-of-payment policy, hospitals should transition their consumables audit model from a manual paradigm to an intelligent, machine-led one. This requires enhanced training for medical staff and the establishment of robust internal monitoring and incentive mechanisms to mitigate cost-shifting risks and reduce initial adaptation costs. Concurrently, collaboration with healthcare security authorities is essential to explore the development of a unified and standardized knowledge base for medical insurance payment rules.
Key words
interrupted time series analysis /
intelligent supervision /
medical insurance claim denial /
medical consumables /
moral hazard /
auditing behavior
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