Xu Huiping, She Qunqing, Zhang Beibei, Zhang Shaogui, Xie Linjun
The First Hospital of Putian City, Putian, China.
The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
Front Public Health. 2025 May 7;13:1453367. doi: 10.3389/fpubh.2025.1453367. eCollection 2025.
This study aims to analyze and compare the impact of the diagnosis-intervention packet (DIP) payment on inpatient medical costs for hematologic malignancies (HM) and solid tumors (ST) patients, and to explore its implications for hospital financial sustainability and payment reform.
Using a retrospective research design, this study focused on HM and ST patients treated before and after the implementation of the DIP payment at a large tertiary general hospital in A city, located in the eastern coastal area of China. Data were collected, organized, and analyzed to compare differences in inpatient medical costs between HM and ST patients and to examine their impact on the income of the department of hematology.
The study included 5,115 cases from both before and after the DIP payment implementation. Post-implementation, the median inpatient medical costs per case decreased from 5,544.45 CNY to 5,169.66 CNY, with costs for both HM and ST hospitalizations showing a decline. Specifically, the inpatient medical costs per case for HM were 5,722.46 (4,471.08, 11,508.78) CNY, higher than those for ST at 4,779.28 (3,056.70, 7,152.64) CNY, and exceeding the DIP payment standard. Wilcoxon signed-rank test and regression analysis indicated that HM inpatient medical costs surpass the standard payments, resulting in financial losses. All findings were statistically significant ( < 0.05). These results suggest a structural mismatch between DIP reimbursement rates and the resource intensity of hematologic malignancy treatment, which may jeopardize the financial viability of hematology departments.
Despite a reduction in median inpatient medical costs following the implementation of the DIP payment, departments treating HM patients continue to experience financial losses due to costs exceeding the payment standard. These findings highlight the need to refine DIP payment standards to better account for clinical complexity and technological advancements. Future reforms should aim to improve alignment between payments and actual care needs to ensure financial sustainability and equity. However, this study is limited by its single-center design and lack of control for potential confounders. Broader multi-center studies with more detailed clinical data are needed to validate and extend these findings.
本研究旨在分析和比较诊断 - 干预套餐（DIP）支付方式对血液系统恶性肿瘤（HM）和实体瘤（ST）患者住院医疗费用的影响，并探讨其对医院财务可持续性和支付改革的意义。
本研究采用回顾性研究设计，聚焦于中国东部沿海A市一家大型三级综合医院实施DIP支付方式前后接受治疗的HM和ST患者。收集、整理并分析数据，以比较HM和ST患者住院医疗费用的差异，并考察其对血液科收入的影响。
该研究纳入了DIP支付方式实施前后的5115例病例。实施后，每例患者的住院医疗费用中位数从5544.45元降至5169.66元，HM和ST住院患者的费用均有所下降。具体而言，HM患者每例的住院医疗费用为5722.46（4471.08，11508.78）元，高于ST患者的4779.28（3056.70，7152.64）元，且超过了DIP支付标准。Wilcoxon符号秩检验和回归分析表明，HM患者的住院医疗费用超过了标准支付额度，导致财务亏损。所有结果均具有统计学意义（P < 0.05）。这些结果表明，DIP报销率与血液系统恶性肿瘤治疗的资源强度之间存在结构不匹配，这可能危及血液科的财务生存能力。
尽管实施DIP支付后住院医疗费用中位数有所降低，但治疗HM患者的科室因费用超过支付标准仍持续面临财务亏损。这些发现凸显了完善DIP支付标准以更好地考虑临床复杂性和技术进步的必要性。未来的改革应旨在改善支付与实际医疗需求之间的匹配度，以确保财务可持续性和公平性。然而，本研究受单中心设计的限制，且未对潜在混杂因素进行控制。需要开展更广泛的多中心研究，并提供更详细的临床数据来验证和扩展这些发现。
