Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Public Health. 2024 Nov 13;12:1375739. doi: 10.3389/fpubh.2024.1375739. eCollection 2024.
In recent years, China has been carrying out the Diagnosis Related Groups (DRGs) payment reform, which has an impact not only on payment methods and medical expenses, but also on the behaviors of medical staff. Some of these behaviors are unexpected by policymakers, such as turning away critically ill patients, disaggregating hospitalization costs, setting up disease groups with higher points, and so on. This phenomenon attracted the attention of some scholars, who put forward a few positive intervention measures, mainly including policy advocacy and system improvement. The scholars believed that the former was more feasible. However, there is a lack of research on the effects and influencing processes of these interventions. Therefore, this study aims to explore the influence of policy advocacy and education on medical staff's adaptation to DRGs payment reform in China and the role of policy cognition in this process, in order to provide experiences for the smooth implementation and sustainable development of DRGs payment system.
A questionnaire survey was conducted among 650 medical staff in five large general hospitals in Zhejiang Province, China, to understand their participation and feedback on policy advocacy and education, their adaptation to the current DRGs payment reform, and their cognition of relevant policies. After descriptive statistical analysis, partial correlation analysis, multiple linear regression models and bias correction Bootstrap sampling method were used to analyze the mediating effect of policy cognition factors.
All respondents had participated in organized collective policy advocacy and education activities in the past year, but the degree of satisfaction and recognition was not very high. 59.5 percent said their adaptation to the DRGs payment reform was average. Nearly half did not regularly pay attention to and participate in the management of the medical costs of patients with DRGs through compliance. And they had a low understanding of the specific rules of DRGs payment and did not form a high policy identity. The mediating effect values of policy cognition were 0.148, 0.152, 0.108, and 0.057, respectively, when the frequency and quality of policy advocacy and education influenced medical staff's adaptive perception and adaptive behaviors.
The organized collective policy advocacy and education can promote medical staff's adaptation to DRGs payment reform by improving their policy cognition, and the action paths are diverse. Policymakers and hospital managers need pay attention to this phenomenon, and formulate demand-centered, value-oriented whole-process advocacy and education strategies while constantly improving the DRGs payment system. All of these provided a basis for further research and practice of positive intervention in DRGs payment reform.
近年来，中国一直在推行按疾病诊断相关分组（DRGs）付费改革，这不仅对支付方式和医疗费用产生了影响，还对医务人员的行为产生了影响。其中一些行为是政策制定者始料未及的，例如拒收危重症患者、分解住院费用、设置点数较高的疾病组等。这种现象引起了一些学者的关注，他们提出了一些积极的干预措施，主要包括政策倡导和制度完善。学者们认为前者更可行。然而，对于这些干预措施的效果和影响过程，缺乏研究。因此，本研究旨在探讨政策倡导和教育对中国医务人员适应 DRGs 付费改革的影响，以及政策认知在这一过程中的作用，为 DRGs 付费制度的顺利实施和可持续发展提供经验。
采用问卷调查法，对浙江省五家大型综合医院的 650 名医务人员进行调查，了解他们对政策倡导和教育的参与和反馈、对当前 DRGs 付费改革的适应情况，以及对相关政策的认知情况。在描述性统计分析的基础上，采用偏相关分析、多元线性回归模型和偏差校正 Bootstrap 抽样方法，分析政策认知因素的中介效应。
所有受访者在过去一年中都参加过有组织的集体政策倡导和教育活动，但满意度和认可度并不高。59.5%的人表示他们对 DRGs 付费改革的适应程度一般。近一半的人没有定期关注和参与通过合规管理 DRGs 患者的医疗费用，他们对 DRGs 付费的具体规则了解甚少，也没有形成很高的政策认同度。政策认知的中介效应值分别为 0.148、0.152、0.108 和 0.057，当政策倡导和教育的频率和质量影响医务人员的适应感知和适应行为时。
有组织的集体政策倡导和教育可以通过提高医务人员的政策认知来促进他们对 DRGs 付费改革的适应，其作用路径是多样的。政策制定者和医院管理者需要关注这一现象，在不断完善 DRGs 付费制度的同时，制定以需求为中心、以价值为导向的全过程倡导和教育策略。这为 DRGs 付费改革的积极干预进一步研究和实践提供了依据。
