中国诊断-干预组合式付费改革对儿童肺炎住院费用的影响：一项中断时间序列分析

Impact of China's diagnosis-intervention packet payment reform on pediatric pneumonia hospitalization costs: an interrupted time series analysis.

作者信息

Zhao Liang, Zeng Kun, Chen Feijia, Li Wei, Zhao Jun

机构信息

Department of pharmacy, Shiyan Maternal and Child Health Hospital, Shiyan, Hubei, China.

Department of Information Statistics, Shiyan Maternal and Child Health Hospital, Shiyan, Hubei, China.

出版信息

Cost Eff Resour Alloc. 2025 Apr 21;23(1):18. doi: 10.1186/s12962-025-00623-x.

DOI:10.1186/s12962-025-00623-x

PMID:40259332

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12013051/

Abstract

BACKGROUND

Pediatric pneumonia remains a major cause of morbidity and mortality, imposing substantial financial burdens on healthcare systems and families. This study evaluates the impact of China's diagnosis-intervention packet (DIP) payment reform on hospitalization costs and care quality for pediatric pneumonia.

METHODS

We retrospectively analyzed hospitalization cost data from a pilot hospital for DIP reform, between January 2019 and December 2023. Cases were categorized into re-reform and post-reform phases based on DIP implementation. Interrupted time series regressions assessed immediate and long-term cost trends and clinical outcomes.

RESULTS

A total of 13,133 pediatric pneumonia hospitalizations were included (4,053 pre-reform; 9,080 post-reform). Median hospitalization costs decreased from 4,150.7 RMB to 3,853.3 RMB, with the most notable reductions in medication costs (261.1 RMB) and comprehensive service fees (103.9 RMB). Interrupted time series analysis showed significant immediate reductions in comprehensive service costs (23.2%, P < 0.001) and medication costs (15.8%, P = 0.031), followed by sustained monthly declines in all types of hospitalization costs. Concurrently, clinical outcomes improved: cure rates increased significantly from 87.0 to 90.6% (P < 0.001) without increased ICU transfers (3.5% vs. 4.6%, P = 0.478).

CONCLUSION

The implementation of DIP payment reform was associated with significant reductions in hospitalization costs for pediatric pneumonia while maintaining key quality indicators such as cure rates and ICU transfer frequencies. The observed cost reductions were primarily driven by lower medication expenses and reduced use of unnecessary diagnostic services, reflecting a shift towards value-based care. These findings underscore the potential of DIP reform to enhance hospital efficiency and financial sustainability without compromising patient care.

摘要

背景

小儿肺炎仍然是发病和死亡的主要原因，给医疗系统和家庭带来了沉重的经济负担。本研究评估了中国诊断-干预组合（DIP）支付改革对小儿肺炎住院费用和护理质量的影响。

方法

我们回顾性分析了一家DIP改革试点医院2019年1月至2023年12月期间的住院费用数据。根据DIP的实施情况，将病例分为改革前和改革后阶段。中断时间序列回归评估了即时和长期的费用趋势及临床结果。

结果

共纳入13133例小儿肺炎住院病例（改革前4053例；改革后9080例）。住院费用中位数从4150.7元降至3853.3元，其中药品费用（261.1元）和综合服务费（103.9元）下降最为显著。中断时间序列分析显示，综合服务费用（23.2%，P<0.001）和药品费用（15.8%，P=0.031）立即显著降低，随后各类住院费用持续逐月下降。与此同时，临床结果有所改善：治愈率从87.0%显著提高到90.6%（P<0.001），而重症监护病房（ICU）转诊率未增加（3.5%对4.6%，P=0.478）。