Objective: The paper analyzes the current status and influencing factors of the medical insurance settlement payment rate under the DIP payment system, providing a basis for improving the DIP payment policy, optimizing internal operations in medical institutions, and ensuring reasonable compensation. Methods: Based on the DIP settlement data from 158 medical institutions in G City from January to March 2024, multiple linear regression analysis was used to investigate the factors affecting the medical insurance settlement payment rate. Results: The empirical results show that lower hospitalization costs, shorter hospital stays were associated with higher medical insurance settlement payment rate (P<0.05). Medical insurance settlement payment rates were significantly lower for tertiary medical institutions and core diseases (P<0.05). The medical insurance settlement payment rate of employees' medical insurance is higher than that of residents' medical insurance, and non-conservative treatment is higher than that of conservative treatment (P<0.05). Conclusion: Healthcare security institutions should optimize payment policy design, dynamically adjust disease category values, improve the mechanism of special case negotiation, enhance the fairness and scientificity of payments, and improve the dynamic adjustment mechanism for the fundraising of the residents' medical insurance fund and benefit standards, ensuring the stable operation of the fund in the long term. Medical institutions should implement refined management, optimize cost accounting, strengthen internal supervision and management, and enhance their adaptability to the DIP payment system reform.
Key words
DIP /
Diagnosis-Intervention Packet /
medical insurance settlement payment rate /
medical insurance payment method reform
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