健康发展与政策研究2026，Vol.29Issue(2)：264-270,286,8.DOI:10.12458/HDPR.202501028
按病种付费对住院—门诊服务转移的影响
The impact of case-based payment on the shift from inpatient to outpatient services
蒋明珠 1应晓华 2王祎宁 2马烨 2刘诗婷2
作者信息
- 1. 南京中医药大学卫生经济管理学院,江苏 南京 210023||江苏重大健康风险管理与中医药防控政策研究中心,江苏 南京 210023
- 2. 复旦大学公共卫生学院,上海 200032
- 折叠
摘要
Abstract
Objective This study attempts to systematically review empirical studies on the shift from inpatient to outpatient services induced by diagnosis-related group(DRG)-based payment reforms,and to provide insights for further deepening medical payment system reform in China.Methods A systematic search was conducted in PubMed,Web of Science,CNKI,Wanfang,and other databases for empirical studies on the shift from inpatient to outpatient services,spanning from database inception to January 1,2025.Two researchers independently screened the literature,extracted data,This study employs descriptive analysis method to conduct qualitative analysis on the included studies.Results A total of 11 studies were included with research periods primarily concentrated in the early stages of payment system reform.Some studies focused on specific diseases or surgical procedures.The main research indicators encompassed three aspects,total volume,costs,and efficiency of inpatient and outpatient services.Particular attention was paid to changes in outpatient service utilization before and after hospital admission and discharge,including outpatient visit rates,frequency,and costs within specific timeframes(e.g.14 days,30 days)before and after admission/discharge.The majority of included empirical studies suggested that DRG-based payment tends to induce a shift from inpatient to outpatient services.From a deeper mechanistic perspective,the institutional structuring capacity of medical insurance payment system reform and the separate payment incentives for inpatient and outpatient services constitute the underlying behavioral drivers.Conclusions The reform of DRG-based payment has influenced the structure of healthcare service utilization and is associated with a risk of shift from inpatient to outpatient care.It is recommended to further advance multi-component medical insurance payment reform,explore innovative outpatient payment strategies,and strengthen dynamic monitoring of service shifting behaviors.关键词
按病种付费/医保支付/转移/住院/门诊Key words
DRG-based payment/medical insurance payment/service shift/inpatient care/outpatient care分类
医药卫生引用本文复制引用
蒋明珠,应晓华,王祎宁,马烨,刘诗婷..按病种付费对住院—门诊服务转移的影响[J].健康发展与政策研究,2026,29(2):264-270,286,8.
