文献类型：期刊文献

中文题名：DRG改革对欠发达地区不同级别中医医院医疗费用及结构的影响——基于双组间断时间序列分析

英文题名：Impact of DRG reform on medical costs and structures in different levels of Chinese medicine hospitals in underdeveloped regions-Based on two groups interrupted time-series

作者：陈蒙恩[1,2];侯浩佳[3];杨敬宇[4];王志伟[2,5]

第一作者：陈蒙恩

机构：[1]北京中医药大学中医学院,北京房山区102400;[2]北京中医药大学管理学院;[3]甘肃中医药大学公共卫生学院;[4]甘肃中医药大学卫生管理学院;[5]北京中医药大学国家中医药发展与战略研究院

第一机构：北京中医药大学中医学院,北京房山区102400

年份：2024

卷号：41

期号：11

起止页码：1246

中文期刊名：中国卫生事业管理

外文期刊名：Chinese Health Service Management

收录：;国家哲学社会科学学术期刊数据库;北大核心:【北大核心2023】；

基金：国家中医药管理局项目“已开展中医药DRG/DIP支付地区的操作方案梳理总结、实施前后评估、补偿模式研究”(ZYZB-2023-435);国家中医药管理局项目“中医医疗服务质量监测评估指标信息标准研究”(GZY-FJS-2022-045)。

语种：中文

中文关键词：DRG;中医医院;双组间断时间序列模型;医疗费用

外文关键词：DRG;Chinese medicine hospitals;two groups interrupted time-series model;medical costs

摘要：目的:探究DRG改革对不同级别中医医院医疗费用及其医药费用结构变动的影响。方法:使用甘肃省A市二级及以上中医医院2017年1月~2022年6月住院患者费用数据,采用描述性统计和双组间断时间序列模型进行对比分析。结果:DRG支付政策改革后,三级中医医院次均住院费用、次均西药费用、次均中成药费用均明显下降(P<0.001),同时次均西药费用占比、次均中成药费用占比持续改革前的下降趋势(P<0.001);二级中医医院次均住院费用、次均中成药费用DRG改革后明显上升(P<0.001),次均西药费用改革后变化不明显(β:=-0.05,P>0.05),而次均西药费用占比改革后仍持续改革前的下降趋势(β:=-0.27,P<0.001),但次均中成药费用占比改革前持续下降的趋势在改革后得到遇制(β:=-0.01,P>0.05)。结论:DRG改革有利于控制中医医院医疗费用,提高中医药使用,对医药费用结构调整有一定促进作用。欠发达地区中医DRG改革应关切医院自身信息化建设和中医特色优势发挥,优化和完善中医药特色诊疗服务的支付内容,加强医疗服务过程中的费用监管与调控,让人民群众从中医药服务中获益。
Objective To explore the impact of DRG reform on medical costs and the changes in the structure of pharmaceuti-cal costs in different levels of Chinese medicine hospitals.Methods Using the cost data of hospitalized patients from January 2017 to June 2022 for secondary level and above Chinese medicine hospitals in A city of Gansu Province,descriptive statistics and two groups interrupted time-series model were implemented to comparatively analyze the changes due to DRG reform.Results After the reform of the DRG payment policy,the average hospitalization cost,average western medicine cost and average Chinese patent medicine cost of tertiary Chinese medicine hospitals have decreased significantly(P<0.001),with the average proportion of west-ern medicine cost and average proportion of Chinese patent medicine cost continuing to decline as before the reform(P<0.001).Secondary Chinese medicine hospitals'average hospitalization cost and average Chinese patent medicine cost increased significantly after the DRG reform(P<0.001),the change of average western medicine cost was not obvious(β_(8)=-0.05,P>0.05),and the average proportion of western medicine cost in secondary Chinese medicine hospitals continued to decline as before the reform(β_(8)=-0.27,P<0.001),while the declining trend of the average proportion of Chinese patent medicine cost was curbed after the reform(β_(8)=-0.01,P>0.05).Conclusion DRG reform is conducive to controlling the medical costs of Chinese medicine hospitals,enhancing the use of Chinese medicine,and contributing to the restructuring of medical costs.In underdeveloped areas,DRG reform of Chinese medicine should be more concerned about the hospital's own information construction and the play of the advantages of Chinese medicine characteristics,optimize and improve the payment content of Chinese medicine characteristic diag-nostic and treatment services,and strengthen the supervision and regulation of costs in the process of medical services,so as to make the people benefit from the Chinese medicine services.