Liu Yaqing, Du Sixian, Cao Jianbo, Niu Haoran, Jiang Feng, Gong Liwen
School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
Huazhong University of Science and Technology's Double First-Class Discipline Platform in Humanities (Research Center for Hospital High-Quality Development), Wuhan, Hubei, People's Republic of China.
Risk Manag Healthc Policy. 2024 Jun 14;17:1623-1637. doi: 10.2147/RMHP.S463276. eCollection 2024.
Diagnosis-related group (DRG) payment policies are increasingly recognized as crucial instruments for addressing health care overprovision and escalating health care costs. The synthetic control method (SCM) has emerged as a robust tool for evaluating the efficacy of health policies worldwide.
This study focused on Panzhihua city in Sichuan Province, a pilot city for DRG payment reform implementation, serving as the treatment group. In contrast, 20 nonpilot cities within the province were utilized as potential control units. A counterfactual control group was constructed to evaluate the changes in average inpatient stay duration and health care organization costs following the DRG payment reform initiated in 2018.
Focusing on Panzhihua, Sichuan Province, the analysis reveals that following the reform in March 2018, the average length of hospital stay in Panzhihua decreased by 1.35 days during 2019-2021. Additionally, the average cost per hospitalization dropped by 855.48 RMB, the average cost of medication per hospitalization decreased by 68.51 RMB, and the average cost of diagnostic and therapeutic procedures per hospitalization declined by 136.37 RMB. While global evidence backs DRGs for efficiency and cost reduction, challenges persist in addressing emerging issues like new conditions.
Since its introduction in 2018, the DRG payment reform in Sichuan Province has effectively reduced both the duration of hospital stays and the operational costs of health care facilities. However, potential drawbacks include compromised service quality and an elevated risk of patient readmission, indicating a need for further refinement in the implementation of DRG payment reforms in China.
诊断相关分组（DRG）支付政策日益被视为解决医疗服务过度供给和医疗费用不断攀升问题的关键手段。合成控制法（SCM）已成为全球评估卫生政策效果的有力工具。
本研究聚焦于四川省攀枝花市，该市是DRG支付改革实施的试点城市，作为治疗组。相比之下，该省内20个非试点城市被用作潜在对照组。构建一个反事实对照组，以评估2018年启动DRG支付改革后平均住院天数和医疗机构成本的变化。
以四川省攀枝花市为例，分析显示，2018年3月改革后，2019 - 2021年期间攀枝花市的平均住院天数减少了1.35天。此外，每次住院的平均费用下降了855.48元，每次住院的平均药品费用下降了68.51元，每次住院的平均诊断和治疗程序费用下降了136.37元。虽然全球证据支持DRG在提高效率和降低成本方面的作用，但在应对新病症等新出现的问题上仍存在挑战。
自2018年引入以来，四川省的DRG支付改革有效缩短了住院天数，降低了医疗机构的运营成本。然而，潜在的缺点包括服务质量受损和患者再入院风险升高，这表明中国DRG支付改革的实施需要进一步完善。
