DRG付费改革的溢出效应研究基于异地住院患者医疗费用水平和结构的分析

骆雪; 姚强; 张苗; 蒋海泥; 张晓丹; 裴益

引用本文：骆雪,姚强,张苗,等.DRG付费改革的溢出效应研究基于异地住院患者医疗费用水平和结构的分析[J].中国卫生政策研究,2025,18(11):48-56

DRG付费改革的溢出效应研究基于异地住院患者医疗费用水平和结构的分析

投稿时间：2025-09-06 修订日期：2025-11-13 PDF全文浏览 HTML全文浏览

骆雪¹，姚强¹，张苗²，蒋海泥³，张晓丹¹，裴益³

1.武汉大学政治与公共管理学院湖北武汉 430072;2.华中科技大学同济医学院医药卫生管理学院湖北武汉 430030;3.华中科技大学同济医学院附属同济医院湖北武汉 430030

摘要:目的研究DRG付费改革对医疗费用影响的溢出效应。方法基于湖北省武汉市某三甲医院住院患者病案数据，运用双重差分法，估计改革对异地住院患者医疗费用的影响。结果 DRG付费实施后，异地患者医疗总费用（β=-0.13）、自付费用（β=-0.22）、药品类费用（β=-0.25）、耗材类费用（β=-0.26）等及其占比显著下降，且异地患者自付费用水平和占比降幅显著大于本地患者，但药品类费用占比的降幅显著小于本地患者，两类人群在自付费用水平和药品类费用占比方面的差距逐渐缩小。结论 DRG付费改革产生了显著的溢出效应，异地患者医疗费用水平下降和结构改善，但异地住院患者医疗费用依然较高，建议加快推进异地就医患者纳入按病种付费管理，加强医院内部运营管理与医保支付方式改革的协同。

关键词:DRG 异地就医医疗费用溢出效应双重差分

基金项目:湖北省卫生经济学会2025年度科研课题（2025-04）

Study on the spillover effects of DRG payment reform： Evidence from the level and structure of medical expenses among non-local inpatients

LUO Xue¹, YAO Qiang¹, ZHANG Miao², JIANG Hai-ni³, ZHANG Xiao-dan¹, PEI Yi³

1.School of Political Science and Public Administration， Wuhan University， Wuhan Hubei 430072， China;2.School of Medicine and Health Management， Tongji Medical College， Huazhong University of Science and Technology， Wuhan Hubei 430030， China;3.Tongji Hospital Affiliated to Tongji Medical College， Huazhong University of Science and Technology， Wuhan Hubei 430030， China

Abstract:Objective This study aims to investigate the spillover effects of the Diagnosis-Related Groups payment reform on medical expenditures.Methods Based on the medical record data of inpatients in a tertiary Grade A hospital in Wuhan， Hubei Province， the Difference-in-Differences method was applied to estimate the impact of the DRG reform on medical expenditures for non-local patients.Results After the implementation of DRG payment， the total medical expenses （β=-0.13）， out-of-pocket expenses （β=-0.22）， drug expenses （β=-0.25）， consumable expenses（β=-0.26）decreased significantly. Meanwhile， the reduction ranges of the level and proportion of out-of-pocket expenses for non-local inpatients were significantly larger than those for local inpatients. However， the reduction range of the proportion of drug expenses for non-local inpatients was significantly smaller than that for local inpatients. The gaps between the two groups in terms of the level of out-of-pocket expenses and the proportion of drug expenses gradually narrowed.Conclusion The DRG payment reform has produced a significant spillover effect， leading to a decrease in the medical expense level and an improvement in the expense structure for non-local inpatients. However， the medical expenses of non-local inpatients remain relatively high. It is suggested to accelerate the inclusion of non-local inpatients in disease-specific payment management and strengthen the coordination between the hospital's internal operation management and the reform of medical insurance payment methods.

Key words:Diagnosis-Related Groups（DRG） Non-local medical treatment Medical expenses Spillover effect Difference-in-Differences

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