摘要
利用施行按DRG预付费制度这一外生冲击,基于北京市神经系统疾病患者住院病案首页和门诊电子病历数据,实证分析DRG付费改革对医疗服务质量的影响,结果显示:付费改革显著提升了医疗服务质量和效率,在资源消耗减少的同时降低了住院总死亡率和再入院率,并且调节了住院费用结构;但是,付费改革也引起病例组合指数的下降,出院后30天再门诊率的升高,以及挑选病人、诊断升级、成本转移等策略性行为。据此建议:持续监测,追踪医疗服务质量变化;关注非预期行为,制定有针对性的监管措施;评估改革溢出效应,加强付费改革与其他政策的协同性。
Taking advantage of the exogenous impact of the implementation of DRG prepayment system,this paper empirically analyzes the impact of the prepayment reform by DRG on the quality of medical services based on the data of in-patient medical records and outpatient electronic medical records of patients with neurological diseases in Beijing.The results show that the reform significantly improves the quality and efficiency of medical services,reduces the total inpatient mortality and readmission rate while reducing resource consumption,and adjusts the structure of hospitalization expenses.However,the payment reform also leads to a decline in CMI,an increase in 30-day post-discharge readmissions,and strategic behaviors including patient selection,diagnostic upgrading,and cost shifting.Based on this,the following suggestions are put forward such as continuous monitoring and tracking of changes in medical service quality,paying attention to unexpected behavior and formulating targeted supervision measures,and evaluating the spillover effects of the reform and strengthening the synergy between payment reforms and other policies.
作者
曹珍
郭默宁
管仲军
CAO Zhen;GUO Moning;GUAN Zhongjun
出处
《社会保障研究》
北大核心
2024年第3期52-69,共18页
Social Security Studies
基金
国家社会科学基金项目“公益类事业单位国有资产使用效益优化的监管机制研究”(19BZZ093)
北京卫生健康大数据与政策研究中心项目“按疾病诊断相关分组预付费改革对北京市医疗服务质量的影响研究”(202302101)的阶段性成果。
关键词
DRG
预付费制度
医疗服务质量
DRG
prepayment system
quality of medical services
