健康发展与政策研究2025，Vol.28Issue(6)：715-723,9.DOI:10.12458/HDPR.202509093
DRG体系下中医疗效价值付费政策的实施效果
Implementation examination of pay-for-performance policy for Traditional Chinese Medicine under the DRG system
摘要
Abstract
Objective This study aims to evaluate the impact of the pay-for-performance policy under the Diagnosis-Related Groups(DRG)system for dominant Traditional Chinese Medicine(TCM)diseases on patients'medical expenses,hospital length of stay,hospital service volume,and efficiency.The empirical evidence obtained to support the scientific validity and feasibility of this payment method could offer a reference in deepening the reform of the medical insurance payment system.Methods This study selected a designated key development unit of a national TCM specialty as the research setting.The Difference-in-Differences(DID)model was used to analyze the differences in various indicators between insured patients(observation group)and non-insured patients(control group)before and after the implementation of the payment reform policy.Results A total of 713 cases were included,consisting of 296 cases before the policy implementation and 417 cases after.There were 475 cases covered by local medical insurance and 238 cases classified as others(including intra-provincial non-local,trans-provincial non-local,and self-pay).Following policy implementation,the average quarterly case numbers in both the observation group and the control group[(56.6±16.77)cases and(26.80±10.18)cases,respectively]were higher than those before implementation[(32.00±5.02)cases and(17.33±6.12)cases].Conversely,the average total hospitalization costs[(9 641.73±3 469.69)yuan and(13 827.50±12 889.03)yuan]were lower than those before implementation[(15 952.75±10 907.07)yuan and(17 967.68±16 787.22)yuan].Additionally,the average length of hospital stay for both groups was lower,and the proportion of medical service income was higher than before the policy implementation.Before and after implementation,except for medical technology and nursing fees,the observation group showed a significantly greater reduction in other cost categories compared to the control group(β＜0,P＜0.05).However,there was no statistically significant difference in the change of hospital service volume between the two groups(P＞0.05).Tests for parallel trends,placebo effects,and heterogeneity analysis confirmed that the results of the DID regression model were reliable.Conclusions The pay-for-performance policy for TCM significantly reduced the average total cost per case of dominant TCM diseases.Specifically,the costs of treatment,drugs,and consumables decreased most significantly.Consequently,the cost structure was optimized and hospital stay duration decreased to reach an enhanced hospital efficiency.关键词
疗效价值付费/中医优势病种/疾病诊断相关分组支付/双重差分模型Key words
pay-for-performance/dominant TCM diseases/DRG payment/difference-in-differences(DID)model分类
医药卫生引用本文复制引用
毛宇凡,周良荣..DRG体系下中医疗效价值付费政策的实施效果[J].健康发展与政策研究,2025,28(6):715-723,9.基金项目
湖南省医疗保障研究会年度课题(2024A06) （2024A06）
湖南省卫生健康委重大资助课题(2024WTA01) （2024WTA01）
