Cao Zhen, Liu Xiaoyu, Wang Xiangzhen, Guo Moning, Guan Zhongjun
School of Public Health, Capital Medical University, Beijing, People's Republic of China.
School of Statistics, Capital University of Economics and Business, Beijing, People's Republic of China.
Risk Manag Healthc Policy. 2024 Jun 11;17:1547-1560. doi: 10.2147/RMHP.S458005. eCollection 2024.
As one of the pioneering pilot cities in China's extensive Diagnosis Related Groups (DRG) -based prepayment reform, Beijing is leading a comprehensive overhaul of the prepayment system, encompassing hospitals of varying affiliations and tiers. This systematic transformation is rooted in extensive patient group data, with the commencement of actual payments on March 15, 2022. This study aims to evaluate the effectiveness of DRG payment reform by examining how it affects the cost, volume, and utilization of care for patients with neurological disorders.
Utilizing the exogenous shock resulting from the implementation of the DRG-based prepayment system, we adopted the Difference-in-Differences (DID) approach to discern changes in outcome variables among DRG payment cases, in comparison to control cases, both before and following the enactment of the DRG policy. The analytical dataset was derived from patients diagnosed with neurological disorders across all hospitals in Beijing that underwent the DRG-based prepayment reform. Strict data inclusion and exclusion criteria, including reasonableness tests, were applied, defining the pre-reform timeframe as March 15th through October 31st, 2021, and the post-reform timeframe as the corresponding period in 2022. The extensive dataset encompassed 53 hospitals and encompassed hundreds of thousands of cases.
The implementation of DRG-based prepayment resulted in a substantial 12.6% decrease in total costs per case and a reduction of 0.96 days in length of stay. Additionally, the reform was correlated with significant reductions in overall in-hospital mortality and readmission rates. Surprisingly, the study unearthed unintended consequences, including a significant reduction in the proportion of inpatient cases classified as surgical patients and the Case Mix Index (CMI), indicating potential strategic adjustments by providers in response to the introduction of DRG payments.
The DRG payment reform demonstrates substantial effects in restraining cost escalation and enhancing quality. Nevertheless, caution must be exercised to mitigate potential issues such as patient selection bias and upcoding.
作为中国基于疾病诊断相关分组（DRG）的预付费改革的首批试点城市之一，北京正在引领预付费系统的全面改革，涉及不同隶属关系和层级的医院。这一系统性变革基于广泛的患者分组数据，并于2022年3月15日开始实际支付。本研究旨在通过考察DRG支付改革如何影响神经系统疾病患者的医疗成本、医疗量和医疗服务利用情况，来评估其有效性。
利用基于DRG的预付费系统实施所产生的外部冲击，我们采用双重差分法（DID）来识别DRG支付案例与对照案例在DRG政策颁布前后结果变量的变化。分析数据集来源于北京所有接受基于DRG预付费改革的医院中被诊断为神经系统疾病的患者。应用了严格的数据纳入和排除标准，包括合理性检验，将改革前的时间框架定义为2021年3月15日至10月31日，改革后的时间框架定义为2022年的相应时期。广泛的数据集涵盖53家医院和数十万病例。
基于DRG的预付费实施导致每例病例的总成本大幅下降12.6%，住院天数减少0.96天。此外，改革还与住院总死亡率和再入院率的显著降低相关。令人惊讶的是，该研究发现了一些意外后果，包括被归类为手术患者的住院病例比例和病例组合指数（CMI）显著下降，这表明医疗服务提供者可能针对DRG支付的引入进行了战略调整。
DRG支付改革在抑制成本上升和提高质量方面显示出显著效果。然而，必须谨慎行事以减轻潜在问题，如患者选择偏倚和高编。
