Institute of Fiscal and Finance, Shandong Academy of Social Sciences, Jinan, China.
Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Public Health. 2024 Jul;232:68-73. doi: 10.1016/j.puhe.2024.04.021. Epub 2024 May 14.
There is growing evidence that differences exist between rural and urban residents in terms of health, access to care and the quality of health care received, especially in low- and middle-income countries (LMICs). To improve health equity and the performance of health systems, a diagnosis-related group (DRG) payment system has been introduced in many LMICs to reduce financial risk and improve the quality of health care. The aim of this study was to examine the impact of DRG payments on the health care received by rural residents in China, and to help policymakers identify and design implementation strategies for DRG payment systems for rural residents in LMICs.
Health impact assessment.
This study compared the impact of DRG payments on the healthcare received by rural residents in China between the pre- and post-reform periods by applying a difference-in-difference (DID) methodology. The study population included individuals with three common conditions; namely, cerebral infarction, transient ischaemic attack (TIA), and vertebrobasilar insufficiency (VBI). Data on patient medical insurance type were assessed, and those who did not have rural insurance were excluded.
This study included 13,088 patients. In total, 33.63% were from Guangdong (n = 4401), 38.21% were from Shandong (n = 5002), and 28.16% were from Guangxi (n = 3685). The DID results showed that the implementation of DRGs was positively associated with hospitalization expense (β = 0.265, P = 0.000), treatment expense (β = 0.343, P = 0.002), drug expense (β = 0.607, P = 0.000), the spending of medical insurance funds (β = 0.711, P = 0.000) and out-of-pocket costs (β = 0.164, P = 0.000).
The findings of this study suggest that the implementation of DRG payments increases health care costs and the financial burden on health systems and rural patients in LMICs. This is contrary to the original intention of implementing the DRG payment system.
越来越多的证据表明，农村和城市居民在健康、获得医疗服务的机会和接受的医疗服务质量方面存在差异，尤其是在中低收入国家（LMICs）。为了改善健康公平和卫生系统绩效，许多 LMICs 引入了按疾病诊断相关分组（DRG）付费系统，以降低财务风险并提高医疗质量。本研究旨在考察 DRG 支付对中国农村居民所获得的医疗服务的影响，并帮助决策者为 LMICs 的农村居民确定和设计 DRG 支付系统的实施策略。
健康影响评估。
本研究通过应用差异（DID）方法，比较了中国农村居民在改革前后 DRG 支付对其医疗服务的影响。研究人群包括三种常见疾病的患者：脑梗死、短暂性脑缺血发作（TIA）和椎基底动脉供血不足（VBI）。评估了患者医疗保险类型的数据，排除了没有农村保险的患者。
本研究共纳入 13088 名患者。其中，33.63%来自广东（n=4401），38.21%来自山东（n=5002），28.16%来自广西（n=3685）。DID 结果表明，DRGs 的实施与住院费用（β=0.265，P=0.000）、治疗费用（β=0.343，P=0.002）、药品费用（β=0.607，P=0.000）、医疗保险基金支出（β=0.711，P=0.000）和自付费用（β=0.164，P=0.000）呈正相关。
本研究结果表明，DRG 支付的实施增加了中低收入国家卫生系统和农村患者的医疗服务成本和财务负担，这与实施 DRG 支付系统的初衷背道而驰。
