Xiong Yingbei, Yao Yifan, Li Yuehua, Chen Shanquan, Li Yunfei, Lin Kunhe, Xiang Li
Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, People's Republic of China.
Int J Equity Health. 2025 Jan 2;24(1):1. doi: 10.1186/s12939-024-02368-0.
The severe health challenge and financial burden of drug-resistant tuberculosis (DR-TB) continues to be an impediment in China and worldwide. This study aimed to explore the impact of Diagnosis-related group (DRG) payment on medical expenditure and treatment efficiency among DR-TB patients.
This retrospective cohort study included all DR-TB patients from the digitized Hospital Information System (HIS) of Wuhan Pulmonary Hospital and the TB Information Management System (TBIMS) with completed full course of National Tuberculosis Program (NTP) standard treatment in Wuhan from January 2016 to December 2022, excluding patients whose treatment spanned both before and after the DRG timepoint. These patients are all receiving standardized treatment specified by the NTP in designated tuberculosis hospitals. We performed the difference-in-differences (DID) model to investigate 6 primary outcomes. The cost-shifting behaviors were also examined using 4 outpatient and out-of-pocket (OOP) indicators. In the DID model, the baseline period is set from January 2016 to December 2020 before the DRG payment reform, while the treatment period is from January 2021 to December 2022. The payment reform only applied to individuals covered by Wuhan Municipal Medical Insurance, so the treatment group consists of patients insured by this plan, with other patients serving as the control group.
In this study, 279 patients were included in the analysis, their average treatment duration was 692.79 days. We found the DRG payment implementation could effectively reduce the total medical expenditure, total inpatient expenditure, and inpatient expenditure per hospitalization by 28636.03RMB (P < 0.01), 22035.03 RMB (P < 0.01) and 2448.00 RMB (P < 0.05). We also found a reduction in inpatient frequency and inpatient length of stays per hospitalization by 1.32 and 2.63 days with significance. The spillover effects of the DRG payment on outpatient and OOP expenditure were statistically insignificant.
The DRG payment method can effectively control the increase of DR-TB patients' medical expenditure and improve treatment efficiency with the guarantee of care quality. Furthermore, there was no evidence of spillover effects of DRG payment on outpatient and out-of-pocket expenditures.
耐多药结核病（DR-TB）带来的严峻健康挑战和经济负担在中国乃至全球仍然是一个障碍。本研究旨在探讨疾病诊断相关分组（DRG）付费对耐多药结核病患者医疗费用和治疗效率的影响。
这项回顾性队列研究纳入了武汉市肺科医院数字化医院信息系统（HIS）和结核病信息管理系统（TBIMS）中所有在2016年1月至2022年12月期间完成国家结核病规划（NTP）标准全疗程治疗的耐多药结核病患者，排除治疗跨越DRG时间点前后的患者。这些患者均在指定结核病医院接受NTP规定的标准化治疗。我们采用双重差分（DID）模型来研究6个主要结局。还使用4个门诊和自付费用（OOP）指标来检查费用转移行为。在DID模型中，基线期设定为2016年1月至2020年12月，即DRG付费改革之前，而治疗期为2021年1月至2022年12月。付费改革仅适用于武汉市医疗保险覆盖的个人，因此治疗组由该计划参保的患者组成，其他患者作为对照组。
本研究共纳入279例患者进行分析，他们的平均治疗时长为692.79天。我们发现DRG付费的实施可有效降低总医疗费用、总住院费用和每次住院的住院费用，分别降低28636.03元（P < 0.01）、22035.03元（P < 0.01）和2448.00元（P < 0.05）。我们还发现住院次数和每次住院的住院时长分别显著减少了1.32天和2.63天。DRG付费对门诊和自付费用的溢出效应在统计学上不显著。
DRG付费方式能够在保证医疗质量的前提下，有效控制耐多药结核病患者医疗费用的增长并提高治疗效率。此外，没有证据表明DRG付费对门诊和自付费用有溢出效应。
