基于合成控制法的DRG改革对住院费用的影响——以北京市三级公立医院为例

目的: 分析DRG改革对北京市三级公立医院例均住院总费用及其增速、内部结构的短期效应与长期影响。方法: 基于2009-2018年北京市三级公立医院住院费用的年度报表数据,采用合成控制法分析2011年的DRG改革对例均住院总费用及各项费用占比的影响。结果: 与未试点的医院相比,短期内试点医院的例均住院总费用有所降低,药占比下降显著,耗材费用占比增速下降明显,手术、治疗、护理费用占比有所下降,检查、化验费用占比略有上升。长期看,试点医院例均住院总费用与增速超过非试点医院,药占比、手术、治疗、护理费用占比低于非试点医院,耗材费用占比大幅提高,检查、化验费用占比呈现较强的个体差异性。结论: DRG改革短期内对控制费用增长具有积极作用,长期效果有待改善,费用结构有待优化;未来应从发挥“双中心”的多元作用、与三级公立医院绩效考核结合、提高体现医生技术劳动价值的收入等方面完善DRG改革。

The impact of DRG on hospitalization costs based on synthetic control method: Take Beijing's tertiary public hospitals as an example

Objective: To analyze effects of Diagnosis-Related Group (DRG) both in short-term and long-term on total hospitalization costs in tertiary public hospitals in Beijing, including growth rate and internal structure. Methods: This article is based on annual statistical report data of hospitalization costs in tertiary public hospitals in Beijing from 2009 to 2018. A synthetic control method was used to analyze the impact of DRG on the total costs and percentage of each cost. Results: Compared to hospitals that did not pilot, in the short term, the pilot hospitals have seen a reduction in the total cost of inpatients and a significant reduction in the drug cost ratio. The growth rate of the consumables costs ratio decreased significantly. The surgery, treatment, and care costs ratio declined while the examination and laboratory costs ratio increased. In long term, the total cost and growth of pilot hospitals exceeds that of non-pilot hospitals. Drug ratio and surgery, treatment, and care costs ratio remain lower than non-pilot hospitals. The consumables costs ratio has increased significantly. Changes in the examination and laboratory costs show strong individual variability. Conclusion: The DRG has a positive effect on controlling growth of total costs in short-term, long-term effects need to be improved and the cost structure need to be optimized. Next stage, DRG should be improved in three ways:fulfill the multifaceted role of the Twin Centers, integrate with performance appraisal of tertiary public hospitals, increase income reflecting the value of doctors'' skilled labor.