Lin Kunhe, Yao Yifan, Xiong Yingbei, Xiang Li
Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
HUST base of National Institute of Healthcare Security, Wuhan, China.
Int J Equity Health. 2025 May 26;24(1):150. doi: 10.1186/s12939-025-02531-1.
Timely treatment of infectious diseases is essential to prevent transmission and protect public health. However, the substantial direct economic burden often impedes infectious disease patients from accessing timely treatment. Currently, China has implemented an innovative payment model called Diagnosis-Intervention Packet (DIP) in 71 pilot cities. This study aims to evaluate the impact of DIP on the direct economic burden of infectious disease inpatients.
The dataset comprises 724,489 inpatient reimbursement records from City A spanning from January 2019 to June 2023. We conducted an interrupted time series analysis (ITSA) on six outcomes for a total of 2384 inpatients, with the top six being high-incidence Category B infectious diseases in City A. Further robustness analyses focusing on inpatients covered by Rural Residents Basic Medical Insurance (URRBMI), as well as those hospitalized for HBV and TB, were conducted to support our findings.
Following the implementation of DIP, we observed downward trends in average inpatient expenditure (β = -237.96, P < 0.01), average drug expenditure (β = -164.21, P < 0.01), average inpatient out-of-pocket expenditures (OOPs) (β = -124.58, P < 0.05), and the proportion of OOPs (β = -0.31, P < 0.01). These correspond to monthly decreasing slopes of ¥237.96, ¥164.21, ¥124.58, and 0.31%, respectively. When analyzing the proportion of OOPs by catalog status, a significant decline was observed only for non-catalog items, with a decreasing slope of 0.19% (β = -0.19, P < 0.01). The reintroduction of ITSA focusing on URRBMI inpatients, as well as HBV and TB inpatients, demonstrated the robustness of the results.
The DIP appears to contribute to reducing the direct economic burden for patients with infectious diseases. On the one hand, DIP seems to facilitate a reduction in inpatient medical expenditures, particularly by containing drug expenditures, which constitute a major component of spending for infectious disease patients. On the other hand, the decline in the proportion of OOPs is primarily concentrated in out-of-catalog items, suggesting that the DIP model may help limit doctors' tendencies to shift costs onto patients.
及时治疗传染病对于预防传播和保护公众健康至关重要。然而，巨大的直接经济负担常常阻碍传染病患者获得及时治疗。目前，中国已在71个试点城市实施了一种名为诊断-干预组合（DIP）的创新支付模式。本研究旨在评估DIP对传染病住院患者直接经济负担的影响。
数据集包括来自A市2019年1月至2023年6月的724489份住院报销记录。我们对总共2384名住院患者的六项结果进行了中断时间序列分析（ITSA），其中前六项是A市乙类高发传染病。进一步针对农村居民基本医疗保险（URRBMI）覆盖的住院患者以及因乙肝和结核病住院的患者进行了稳健性分析，以支持我们的研究结果。
实施DIP后，我们观察到平均住院费用（β=-237.96，P<0.01）、平均药品费用（β=-164.21，P<0.01）、平均住院自付费用（OOPs）（β=-124.58，P<0.05）以及自付费用比例（β=-0.31，P<0.01）呈下降趋势。这些分别对应每月237.96元、164.21元、124.58元和0.31%的下降斜率。在按目录状态分析自付费用比例时，仅非目录项目出现了显著下降，下降斜率为0.19%（β=-0.19，P<0.01）。针对URRBMI住院患者以及乙肝和结核病住院患者重新进行的ITSA证明了结果的稳健性。
DIP似乎有助于减轻传染病患者的直接经济负担。一方面，DIP似乎有助于降低住院医疗费用，特别是通过控制药品费用，药品费用是传染病患者支出的主要组成部分。另一方面，自付费用比例的下降主要集中在非目录项目上，这表明DIP模式可能有助于限制医生将费用转嫁给患者的倾向。
