A comparative study of evaluation indicators of different clinical departments before and after the reform of diagnosis-related group payment method under total amount control_West China Medical Journal

Authors：

LIU Kexin ^1,2 ,  CHENG Yongzhong ^3,4

1. Medical Equipment Department, Panzhihua Central Hospital, Panzhihua, Sichuan 617067, P. R. China;
2. Business School, Sichuan University, Chengdu, Sichuan 610065, P. R. China;
3. Party Committee Office, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
4. Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CHENG Yongzhong, Email: chengyz@scu.edu.cn

Keywords：

Medical insurance payment reform; diagnosis-related groups; interrupted time series analysis; department evaluation

DOI：

10.7507/1002-0179.202211121

Video：

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Objective To explore the impact of diagnosis-related group (DRG) payment method reform under total amount control on neurology and neurosurgery departments. Methods The DRG grouping data of the Department of Neurology and the Department of Neurosurgery of Panzhihua Central Hospital from January 2018 to December 2020 were collected, and the mature DRG evaluation indexes in China were selected. Using the interrupt time series analysis method, the DRG-related indexes of the two departments before and after the introduction of the performance appraisal plan in July 2019 were compared, to evaluate the intervention effects on the two departments. Results Both neurology and neurosurgery departments showed a slow downward trend in the overall medical service capacity under the DRG payment. The efficiency of medical services showed a slow upward trend and the consumption of medical expenses showed a slow downward trend in the Department of Neurology, while the efficiency of medical services showed a slow downward trend and the consumption of medical expenses showed a slow upward trend in the Department of Neurosurgery. According to the results of interrupt time series analysis, in the Department of Neurosurgery, the total weight showed a significant downward trend before intervention (β₁=?5.526, P=0.003), and the downward trend became sluggish after intervention, with a statistically significant slope difference before and after intervention (β₃=4.546, P=0.047); the case-mix index showed a downward trend before intervention (β₁=?0.050, P<0.001), and no obvious trend after intervention, with a statistically significant slope difference before and after intervention (β₃=0.052, P=0.001); the cost consumption index showed no obvious downward trend before intervention (β₁=?0.006, P=0.258), and an upward trend after intervention, with a statistically significant slope difference before and after intervention (β₃=0.027, P=0.032). The impact of this assessment plan on the Department of Neurology was not statistically significant (P>0.05), needing further observation. Conclusions The reform of DRG payment method under total amount control has different effects on the evaluation indicators of clinical departments of different natures. It is recommended to implement classified management and assessment for clinical departments of different natures.

Citation： LIU Kexin, CHENG Yongzhong. A comparative study of evaluation indicators of different clinical departments before and after the reform of diagnosis-related group payment method under total amount control. West China Medical Journal, 2023, 38(12): 1819-1823. doi: 10.7507/1002-0179.202211121 Copy

1.	羅娟, 汪泓, 廖曉瑜. 上海城鎮職工醫療保險費用影響研究——基于供給誘導需求的視角. 現代管理科學, 2015(5): 69-71.
2.	楊吉明. 醫療費用控制與衛生經濟學的基石研究. 行政事業資產與財務, 2019(18): 1-9.
3.	劉榮飛, 薛梅, 李紫靈. DRG 的國內外研究進展. 衛生經濟研究, 2020, 37(10): 42-45, 48.
4.	何青, 江芹, 郎婧婧, 等. 典型國家和地區 DRG 實施過渡期經驗探討. 中國衛生經濟, 2017, 36(11): 93-96.
5.	劉芬, 孟群. DRG 支付體系構建的國際經驗及啟示. 中國衛生經濟, 2018, 37(8): 93-96.
6.	李菲. DRGs 在醫院醫療費用支付中的應用研究——基于英國、德國和美國的實證分析. 衛生經濟研究, 2019, 36(1): 32-37.
7.	常小婉, 萬勝凱, 尼燕, 等. 基于 DRGs 的公立醫院控費實踐與成效分析. 中國衛生事業管理, 2020, 37(1): 35-37.
8.	Wagner AK, Soumerai SB, Zhang F, et al. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther, 2002, 27(4): 299-309.
9.	Zhang F, Wagner AK, Soumerai SB, et al. Methods for estimating confidence intervals in interrupted time series analyses of health interventions. J Clin Epidemiol, 2009, 62(2): 143-148.
10.	Ariel L. Conducting interrupted time-series analysis for single- and multiple-group comparisons. Stata J, 2015, 15(2): 480-500.
11.	李洪錚, 唐紫君, 薛龍, 等. 疾病診斷相關分組政策實施對三明市公立醫院住院服務效率及費用的影響. 中國衛生資源, 2021, 24(4): 393-396, 404.
12.	胡廣宇, 劉立煌, 吳世超, 等. 基于間斷時間序列分析的 DRG-PPS 改革效果研究. 中國衛生政策研究, 2019, 12(10): 23-28.
13.	王洪彬, 江芹, 張振忠. 按病例組合付費實施效果的實證研究. 中國衛生經濟, 2015, 34(7): 17-19.
14.	季新強, 王小藝, 張耀光. 北京醫耗聯動綜合改革對肺癌手術病例住院費用的影響. 中國醫院管理, 2022, 42(1): 64-67.
15.	白云, 白玉祥, 潘峰, 等. 基于間斷時間序列分析的電子病歷實施效果研究. 中國衛生質量管理, 2014, 21(1): 82-85.
16.	陳治水, 冷家驊, 劉憶, 等. 運用間斷時間序列分析北京市門診特種病醫保政策實施效果. 中國衛生統計, 2019, 36(1): 141-143.
17.	郎婧婧, 周海龍, 于雪梅, 等. 總額預付改革對住院患者費用控制效果的研究. 中國衛生經濟, 2017, 36(2): 20-22.
18.	李超凡, 何佳琳, 楊燕綏. DRGs 支付方式改革前后醫院技術效率比較研究——以 F 市為例. 中國衛生事業管理, 2021, 38(9): 641-644.
19.	劉夢靈, 賈明遠, 林倩, 等. 取消耗材加成政策對縣級公立醫院醫療費用結構的影響. 中國衛生經濟, 2021, 40(7): 29-32.
20.	吳晶晶, 陳志仙, 張昕男, 等. 江蘇省公立醫院綜合改革效果評價研究——基于間斷時間序列分析. 中國衛生事業管理, 2018, 35(3): 163-166.
21.	劉文鳳, 玄桂英, 韓梅, 等. 基本醫保支付方式內在邏輯關系與改革路徑選擇. 中國衛生事業管理, 2018, 35(10): 737-739.

1. 羅娟, 汪泓, 廖曉瑜. 上海城鎮職工醫療保險費用影響研究——基于供給誘導需求的視角. 現代管理科學, 2015(5): 69-71.
2. 楊吉明. 醫療費用控制與衛生經濟學的基石研究. 行政事業資產與財務, 2019(18): 1-9.
3. 劉榮飛, 薛梅, 李紫靈. DRG 的國內外研究進展. 衛生經濟研究, 2020, 37(10): 42-45, 48.
4. 何青, 江芹, 郎婧婧, 等. 典型國家和地區 DRG 實施過渡期經驗探討. 中國衛生經濟, 2017, 36(11): 93-96.
5. 劉芬, 孟群. DRG 支付體系構建的國際經驗及啟示. 中國衛生經濟, 2018, 37(8): 93-96.
6. 李菲. DRGs 在醫院醫療費用支付中的應用研究——基于英國、德國和美國的實證分析. 衛生經濟研究, 2019, 36(1): 32-37.
7. 常小婉, 萬勝凱, 尼燕, 等. 基于 DRGs 的公立醫院控費實踐與成效分析. 中國衛生事業管理, 2020, 37(1): 35-37.
8. Wagner AK, Soumerai SB, Zhang F, et al. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther, 2002, 27(4): 299-309.
9. Zhang F, Wagner AK, Soumerai SB, et al. Methods for estimating confidence intervals in interrupted time series analyses of health interventions. J Clin Epidemiol, 2009, 62(2): 143-148.
10. Ariel L. Conducting interrupted time-series analysis for single- and multiple-group comparisons. Stata J, 2015, 15(2): 480-500.
11. 李洪錚, 唐紫君, 薛龍, 等. 疾病診斷相關分組政策實施對三明市公立醫院住院服務效率及費用的影響. 中國衛生資源, 2021, 24(4): 393-396, 404.
12. 胡廣宇, 劉立煌, 吳世超, 等. 基于間斷時間序列分析的 DRG-PPS 改革效果研究. 中國衛生政策研究, 2019, 12(10): 23-28.
13. 王洪彬, 江芹, 張振忠. 按病例組合付費實施效果的實證研究. 中國衛生經濟, 2015, 34(7): 17-19.
14. 季新強, 王小藝, 張耀光. 北京醫耗聯動綜合改革對肺癌手術病例住院費用的影響. 中國醫院管理, 2022, 42(1): 64-67.
15. 白云, 白玉祥, 潘峰, 等. 基于間斷時間序列分析的電子病歷實施效果研究. 中國衛生質量管理, 2014, 21(1): 82-85.
16. 陳治水, 冷家驊, 劉憶, 等. 運用間斷時間序列分析北京市門診特種病醫保政策實施效果. 中國衛生統計, 2019, 36(1): 141-143.
17. 郎婧婧, 周海龍, 于雪梅, 等. 總額預付改革對住院患者費用控制效果的研究. 中國衛生經濟, 2017, 36(2): 20-22.
18. 李超凡, 何佳琳, 楊燕綏. DRGs 支付方式改革前后醫院技術效率比較研究——以 F 市為例. 中國衛生事業管理, 2021, 38(9): 641-644.
19. 劉夢靈, 賈明遠, 林倩, 等. 取消耗材加成政策對縣級公立醫院醫療費用結構的影響. 中國衛生經濟, 2021, 40(7): 29-32.
20. 吳晶晶, 陳志仙, 張昕男, 等. 江蘇省公立醫院綜合改革效果評價研究——基于間斷時間序列分析. 中國衛生事業管理, 2018, 35(3): 163-166.
21. 劉文鳳, 玄桂英, 韓梅, 等. 基本醫保支付方式內在邏輯關系與改革路徑選擇. 中國衛生事業管理, 2018, 35(10): 737-739.

West China Medical Journal

A comparative study of evaluation indicators of different clinical departments before and after the reform of diagnosis-related group payment method under total amount control

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