摘要
目的基于双重差分(DID)模型评价按病种分值付费(DIP)对后循环缺血患者医疗费用的影响。方法选取后循环缺血为研究疾病,为分析DIP实施效果,本研究以参加DIP改革结算的患者数据为观察组,以未参加DIP结算的患者数据为对照组。运用倾向得分匹配法(PSM)及DID模型评估DIP改革对患者医疗费用、费用结构的影响。结果共计纳入后循环缺血患者2953例,其中观察组1418例、对照组1535例,匹配后两组人群均为1262例,基线特征差异无统计学意义。DID模型结果显示,相比对照组,观察组次均住院费用降低3.70%,差异无统计学意义;其中药占比下降2.70%,差异有统计学意义,耗占比、检查检验占比以及医疗服务项目占比变化不显著。结论DIP支付方式改革可显著降低患者的药占比,未来需进一步验证对医疗费用的影响。
Objective To evaluate the impact of diagnosis-intervention packet(DIP)on the medical expenses of patients with posterior circulation ischemia based on the different-in-difference(DID)model.Methods Posterior circulation ischemia was selected as the disease under study.To analyze the implementation effect of DIP,the patients’medical record participating in DIP reform were taken as the intervention group in this study,and the patients’medical record not participating in DIP reform were taken as the control group.The propensity score matching(PSM)method and the DID model were used to evaluate the impact of the DIP reform on patients'medical expenses and the structure Results A total of 2953 patients with posterior circulation ischemia are included,including 1418 patients in the intervention group and 1535 patients in the control group,and 1262 patients in both groups after matching,with no statistical difference in baseline characteristics.The results of the DID model show that compared with the control group,the total medical expenses of the intervention group decrease by 3.70%,the difference is not statistically significant.The proportion of drug expenses decreases by 2.70%,which is statistically significant.The proportion of consumables,examination and laboratory test,and medical services does not change significantly.Conclusions DIP reform can significantly reduce the proportion of drug expenses for patients.In the future,the impact on medical expenses needs to be further verified.
作者
陈莉莉
石佳凡
曹林林
袁桃花
朱玄
王端权
CHEN Li-Li;SHI Jia-Fan;CAO Lin-Lin;YUAN Tao-Hua;ZHU Xuan;WANG Duan-Quan(Information and Statistics Center&Healthcare Security Office,Henan Second Provincial People’s Hospital,Zhengzhou 451191,China;School of Pharmaceutical Business,Zhejiang Pharmaceutical University,Ningbo 315599,China;Healthcare Security Office,Tianjin First Central Hospital,Tianjin 300190,China)
出处
《中国药物经济学》
2025年第12期5-9,共5页
China Journal of Pharmaceutical Economics
基金
浙江省药学会药物经济学与卫生技术评估专项科研资助项目(2023ZYJ06)。
关键词
按病种分值付费
后循环缺血
倾向得分匹配法
双重差分模型
政策评估
Diagnosis-intervention packet
Posterior circulation ischemia
Propensity Score Matching
Difference-in-Difference
Policy evaluation
