按病种分值付费对基层医疗卫生机构住院人次和费用的影响分析OA北大核心CSTPCD

Objective To evaluate the impact of diagnosis-intervention packet(DIP)payment reform on inpatient service volume and expenditure in primary healthcare institutions.Methods Inpatient cost data from Z city were collected over 36 consecutive months from 2020 to 2022.A single-group interrupted time series analysis was employed to assess changes in inpatient service volume and costs before and after the reform.Results A declining trend in discharge rates was observed in both hospitals and primary healthcare institutions after DIP reform.However,the proportion of discharges from primary healthcare institutions did not show a significant downward trend.Total inpatient medical expenses exhibited a substantial upward trend pre-reform,increasing by an average of 1.2029 million yuan per month(P=0.001),but showed a decreasing trend post-reform.The trend in average medical expenses per admission was not statistically significant.Both out-of-pocket expenses and co-payments decreased after the reform.Out-of-pocket expenses decreased by an average of 1.18 yuan monthly(P=0.033),while co-payments decreased by an average of 2.08 yuan monthly(P＜0.001).Conclusions The DIP reform effectively reduced unnecessary hospitalizations without evident siphoning of patients from primary healthcare institutions to larger hospitals.The reform brings patients reductions in both out-of-pocket expenses and co-payments.