Teng Jiali, Li Qian, Song Guihang, Han Youli
School of Public Health, Capital Medical University, Beijing, People's Republic of China.
Department of Medical Services Management, Gansu Healthcare Security Administration, Lanzhou, Gansu, People's Republic of China.
Risk Manag Healthc Policy. 2024 Aug 29;17:2055-2065. doi: 10.2147/RMHP.S467471. eCollection 2024.
To control medical costs and regulate the behavior of providers, China has formed an original widely piloted case-based payment under the regional global budget, called the Diagnosis-Intervention Packet (DIP). This study aimed to evaluated the impact of the DIP payment reform on medical costs, quality of care, and medical service capacity in a less-developed pilot city in Northwest China.
We used the de-identified case-level discharge data of hospitalized patients from January 2021 to June 2022 in pilot and control cities located in the same province. We performed difference-in-differences (DID) analysis to examine the differential impact of the DIP reform for the entire sample and between secondary and tertiary hospitals.
The DIP payment reform resulted in a significant decrease of total expenditure per case in the entire sample (5.5%, < 0.01) and tertiary hospitals (9.3%, < 0.01). In-hospital mortality rate decreased significantly in tertiary hospitals (negligible in size, < 0.05), as did all-cause readmission rate within 30 days in the entire sample (1.1 percentage points, < 0.01) and secondary hospitals (1.4 percentage points, < 0.01). Proportion of severe patients increased significantly in the entire sample (1.2 percentage points, < 0.05) and tertiary hospitals (2.5 percentage points, < 0.01). We did not find the DIP reform was associated with a significant change in relative weight per case.
The DIP payment reform in the less-developed pilot city achieved short-term success in controlling medical costs without sacrificing the quality of care for the entire sample. Compared with secondary hospitals, tertiary hospitals experienced a greater decline in medical costs and received more severe patients. These findings hold lessons for less developed countries or areas to implement case-based payments and remind them of the variations between different levels of hospitals.
为控制医疗成本并规范医疗服务提供者的行为，中国在区域总额预算下形成了一种原创的、广泛试点的基于病例的支付方式，称为病种分值付费（DIP）。本研究旨在评估DIP支付改革对中国西北一个欠发达试点城市的医疗成本、医疗质量和医疗服务能力的影响。
我们使用了来自同一省份试点城市和对照城市2021年1月至2022年6月住院患者的去识别化病例级出院数据。我们进行了双重差分（DID）分析，以检验DIP改革对整个样本以及二级和三级医院的差异影响。
DIP支付改革导致整个样本（5.5%，P<0.01）和三级医院（9.3%，P<0.01）的每例总支出显著下降。三级医院的院内死亡率显著下降（幅度可忽略不计，P<0.05），整个样本（1.1个百分点，P<0.01）和二级医院（1.4个百分点，P<0.01）的30天内全因再入院率也显著下降。整个样本（1.2个百分点，P<0.05）和三级医院（2.5个百分点，P<0.01）中重症患者比例显著增加。我们未发现DIP改革与每例相对权重的显著变化相关。
欠发达试点城市的DIP支付改革在控制医疗成本方面取得了短期成功，且未牺牲整个样本的医疗质量。与二级医院相比，三级医院的医疗成本下降幅度更大，接收的重症患者更多。这些发现为欠发达国家或地区实施基于病例的支付提供了经验教训，并提醒它们注意不同级别医院之间的差异。
