Wang Sisi, Wu Nuan, Wang Huiyi, Zhang Xiaotong, Li Fubang, Wang Xiaohao, Wang Wei
Medical Service Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Medical Insurance Office, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Int J Health Plann Manage. 2024 Mar;39(2):432-446. doi: 10.1002/hpm.3739. Epub 2023 Nov 11.
Paediatric healthcare is always highlighted in medical and health care system reform in China. Zhejiang Province established a new diagnosis-related group (DRG) point payment reform in 2020 to regulate provider behaviours and control medical costs. We conducted this study to evaluate impacts of the DRG point payment policy on provider behaviours and resource usage in children's medical services.
Data from patients' discharge records from July 2019 to December 2020 in Children's Hospital, Zhejiang University School of Medicine were collected for analysis. We employed the interrupted time series approach to reveal the trend before and after the DRG point payment reform and the difference-in-differences analysis to estimate the independent outcome changes attributed to the reform.
We found that the upward trend of length of stay slightly slowed, and the total costs began to decrease at the post-policy stage. Although independent effects of the reform were not presented among the whole sample, the length of stay and hospitalisation costs of moderate-hospital-stay paediatric patients, non-surgical patients, and infant patients were found to decrease rapidly after the reform.
DRG point payments can changed the provider behaviours and eventually reduce healthcare resource usage in children's medical services.
儿科医疗保健在中国医疗卫生体制改革中一直备受关注。浙江省于2020年开展了新的疾病诊断相关分组（DRG）点数付费改革，以规范医疗机构行为并控制医疗费用。我们开展本研究以评估DRG点数付费政策对儿童医疗服务中医疗机构行为和资源使用的影响。
收集了浙江大学医学院附属儿童医院2019年7月至2020年12月患者出院记录的数据进行分析。我们采用中断时间序列方法来揭示DRG点数付费改革前后的趋势，并采用差分分析来估计改革带来的独立结果变化。
我们发现住院时间的上升趋势略有放缓，且在政策实施阶段后总费用开始下降。尽管在整个样本中未呈现改革的独立效应，但发现改革后中度住院时间的儿科患者、非手术患者和婴儿患者的住院时间和住院费用迅速下降。
DRG点数付费可以改变医疗机构行为，并最终减少儿童医疗服务中的医疗资源使用。
