| 引用本文：陈吟, 王香真, 于世昊, 刘晓宇, 隗和澎, 郭默宁.DRG付费是否会导致住院医疗服务向门诊转移——基于PSM-DID模型的实证研究[J].中国卫生政策研究,2024,17(12):52-58 |
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| DRG付费是否会导致住院医疗服务向门诊转移——基于PSM-DID模型的实证研究 |
| 投稿时间：2024-08-01 修订日期：2024-11-10 PDF全文浏览 HTML全文浏览 |
| 陈吟1, 王香真2, 于世昊3, 刘晓宇4, 隗和澎5, 郭默宁1 |
1. 北京市卫生健康大数据与政策研究中心(北京市医院管理研究所) 北京 101117;
2. 北京大学公共卫生学院 北京 100191;
3. 清华大学未央书院 北京 100084;
4. 首都经济贸易大学统计学院 北京 100070;
5. 北京肿瘤医院 北京 100089 |
| 摘要:目的：评估北京地区实施DRG付费改革后医疗服务利用是否发生变化。方法：收集2021年4月—2022年10月参与DRG付费的15家三级综合医院住院病案首页数据，将数据分为改革前(2021年4—10月)和改革后(2022年4—10月)，以享有城镇职工基本医疗保险的病人作为付费组，其他人群作为对照组，采用倾向性评分匹配—双重差分模型分析改革前后平均住院日、住院例均费用、再门诊率是否存在变化。结果:15家三级综合医院改革后平均住院日和次均住院费用呈下降趋势，入院前30天内再门诊率和出院后30天内再门诊率未见明显变化。结论：实施DRG付费后未出现将住院医疗服务需求转移到门诊的情况，但改革带来的长期效应有待进一步评估。 |
| 关键词:卫生政策评估 DRG付费方式 再门诊率 倾向性评分匹配—双重差分 |
| 基金项目:首都卫生发展科研专项(首发2021-1G-3051) |
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| Whether Diagnosis-related Groups will lead to the shift of medical service from inpatient to outpatient settings: An empirical study based on PSM-DID |
| CHEN Yin1, WANG Xiang-zhen2, YU Shi-hao3, LIU Xiao-yu4, WEI He-peng5, GUO Mo-ning1 |
1. Beijing Municipal Health Big Data and Policy Research Center (Beijing Institute of Hospital Management), Beijing 101117, China;
2. School of Public Health, Peking University, Beijing 100191, China;
3. Weiyang College, Tsinghua University, Beijing 100084, China;
4. School of Statistics, Capital University of Economics and Business, Beijing 100070, China;
5. Beijing Cancer Hospital, Beijing 100089, China |
| Abstract:Objective：To evaluate the changes in medical service utilization following the implementation of DRG payment reform in Beijing. Methods：The study collected the home data of inpatient medical records from 15 tertiary general hospitals participating in DRG payment, from April 2021 to October 2022. The data was analyzed before and after the reform, with patients receiving urban employee basic medical insurance as the payment group, and other populations as the control group. A propensity score matching-difference-in-differences model was used to analyze the changes in average length of stay, average cost per hospitalization, and re-outpatient rate before and after the reform. Results：The 15 tertiary general hospitals experienced a downward trend in average days of stay and average cost per hospitalization. However, The changes in outpatient revisits rate within 30 days before admission and hospital revisits rates within 30 days after discharge were found to be not significant after the implementation of DRG payment. Conclusion：The implementation of DRG payment did not result in a transfer of inpatient medical service demand to outpatient service. However, it is important to note that the long-term effect of the reform needs further evaluation. |
| Key words:Health policy evaluation DRG payment method Rate of outpatient revisits PSM-DID |
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