| 引用本文：孙孟雅,刘智勇,吕倩鹏,等.DIP付费对公立医院医疗服务费用及效率的影响基于双重差分法的实证研究[J].中国卫生政策研究,2025,18(7):35-43 |
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| DIP付费对公立医院医疗服务费用及效率的影响基于双重差分法的实证研究 |
| 投稿时间：2025-06-16 修订日期：2025-07-14 PDF全文浏览 HTML全文浏览 |
| 孙孟雅1，刘智勇1，吕倩鹏1，寇志凡1，鲁灿1，李胜男2 |
| 1.华中科技大学同济医学院医药卫生管理学院 湖北武汉 430030;2.沧州市人民医院数据中心 河北沧州 061000 |
| 摘要:目的 评估按病种分值付费（DIP）改革对公立医院住院患者医疗服务费用及效率的影响，并比较外科与内科组差异。方法 采用准干预设计，以河北省某三甲医院2020年1月—2025年3月605 636例出院患者为样本，运用DID模型分析DIP结算（干预组）与非DIP结算（对照组）住院病例关键指标的变化效应。结果 DIP结算病例的住院总费用、自付费用和药品费用均显著下降（P<0.05），检查、护理、化验和治疗费用显著上升（P<0.05）；耗材费用外科组上升30.7%（P<0.1）、内科组下降19.8%（P<0.01）。效率方面，住院天数、时间及费用消耗指数均下降（P<0.01），医疗服务费用占比上升（P<0.01），病例组合指数（CMI）无显著变化。结论 DIP改革有效控费提效，但存在费用转移及科室差异，需优化费用管控与科室管理政策。 |
| 关键词:DIP付费 医疗费用结构 医疗服务效率 双重差分法 |
| 基金项目:国家卫生健康委现代医院管理研究课题重点项目资助（23AB2024001-2） |
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| The impact of DIP payment on medical expense and efficiency in public hospitals： An empirical study based on the difference-in-differences method |
| SUN Meng-ya1, LIU Zhi-yong1, LYU Qian-peng1, KOU Zhi-fan1, LU Can1, LI Sheng-nan2 |
| 1.School of Health Management， Tongji Medical College of Huazhong University of Science and Technology， Wuhan Hubei 430030， China;2.Data Center， Cangzhou People’s Hospital， Cangzhou Hebei 061000， China |
| Abstract:Objective To evaluate the impact of Diagnosis-Intervention Packet （DIP） payment reform on medical service costs and efficiency for inpatients in public hospitals， and to compare differences between surgical and medical groups.Methods A quasi-experimental design was employed， using 605 636 discharged patients from a tertiary hospital in Hebei Province between January 2020 and March 2025 as the sample. The difference-in-differences （DID） model was used to analyze the changes in key indicators between the DIP settlement group （intervention group） and the non-DIP settlement group （control group）.Results Total hospitalization costs， out-of-pocket expenses， and medication costs were significantly reduced in the DIP settlement group （P<0.05）， while costs for examinations， nursing， laboratory tests， and treatments increased significantly （P<0.05）. Material costs increased by 30.7% in the surgical group （P<0.1） and decreased by 19.8% in the medical group （P<0.01）. In terms of efficiency， the average length of stay， time， and cost consumption index all decreased （P<0.01）， while the proportion of medical services increased （P<0.01）. The case mix index （CMI） showed no significant changes.Conclusion The DIP reform effectively controlled costs and improved efficiency， but it also resulted in cost shifting and departmental disparities. Therefore， it is necessary to optimize cost control and departmental management policies. |
| Key words:DIP payment Medical expense structure Medical service efficiency Difference-in-differences method （DID） |
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