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

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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.	罗娟, 汪泓, 廖晓瑜. 上海城镇职工医疗保险费用影响研究——基于供给诱导需求的视角. 现代管理科学, 2015(5): 69-71.
2.	杨吉明. 医疗费用控制与卫生经济学的基石研究. 行政事业资产与财务, 2019(18): 1-9.
3.	刘荣飞, 薛梅, 李紫灵. DRG 的国内外研究进展. 卫生经济研究, 2020, 37(10): 42-45, 48.
4.	何青, 江芹, 郎婧婧, 等. 典型国家和地区 DRG 实施过渡期经验探讨. 中国卫生经济, 2017, 36(11): 93-96.
5.	刘芬, 孟群. DRG 支付体系构建的国际经验及启示. 中国卫生经济, 2018, 37(8): 93-96.
6.	李菲. DRGs 在医院医疗费用支付中的应用研究——基于英国、德国和美国的实证分析. 卫生经济研究, 2019, 36(1): 32-37.
7.	常小婉, 万胜凯, 尼燕, 等. 基于 DRGs 的公立医院控费实践与成效分析. 中国卫生事业管理, 2020, 37(1): 35-37.
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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.	李洪铮, 唐紫君, 薛龙, 等. 疾病诊断相关分组政策实施对三明市公立医院住院服务效率及费用的影响. 中国卫生资源, 2021, 24(4): 393-396, 404.
12.	胡广宇, 刘立煌, 吴世超, 等. 基于间断时间序列分析的 DRG-PPS 改革效果研究. 中国卫生政策研究, 2019, 12(10): 23-28.
13.	王洪彬, 江芹, 张振忠. 按病例组合付费实施效果的实证研究. 中国卫生经济, 2015, 34(7): 17-19.
14.	季新强, 王小艺, 张耀光. 北京医耗联动综合改革对肺癌手术病例住院费用的影响. 中国医院管理, 2022, 42(1): 64-67.
15.	白云, 白玉祥, 潘峰, 等. 基于间断时间序列分析的电子病历实施效果研究. 中国卫生质量管理, 2014, 21(1): 82-85.
16.	陈治水, 冷家骅, 刘忆, 等. 运用间断时间序列分析北京市门诊特种病医保政策实施效果. 中国卫生统计, 2019, 36(1): 141-143.
17.	郎婧婧, 周海龙, 于雪梅, 等. 总额预付改革对住院患者费用控制效果的研究. 中国卫生经济, 2017, 36(2): 20-22.
18.	李超凡, 何佳琳, 杨燕绥. DRGs 支付方式改革前后医院技术效率比较研究——以 F 市为例. 中国卫生事业管理, 2021, 38(9): 641-644.
19.	刘梦灵, 贾明远, 林倩, 等. 取消耗材加成政策对县级公立医院医疗费用结构的影响. 中国卫生经济, 2021, 40(7): 29-32.
20.	吴晶晶, 陈志仙, 张昕男, 等. 江苏省公立医院综合改革效果评价研究——基于间断时间序列分析. 中国卫生事业管理, 2018, 35(3): 163-166.
21.	刘文凤, 玄桂英, 韩梅, 等. 基本医保支付方式内在逻辑关系与改革路径选择. 中国卫生事业管理, 2018, 35(10): 737-739.

1. 罗娟, 汪泓, 廖晓瑜. 上海城镇职工医疗保险费用影响研究——基于供给诱导需求的视角. 现代管理科学, 2015(5): 69-71.
2. 杨吉明. 医疗费用控制与卫生经济学的基石研究. 行政事业资产与财务, 2019(18): 1-9.
3. 刘荣飞, 薛梅, 李紫灵. DRG 的国内外研究进展. 卫生经济研究, 2020, 37(10): 42-45, 48.
4. 何青, 江芹, 郎婧婧, 等. 典型国家和地区 DRG 实施过渡期经验探讨. 中国卫生经济, 2017, 36(11): 93-96.
5. 刘芬, 孟群. DRG 支付体系构建的国际经验及启示. 中国卫生经济, 2018, 37(8): 93-96.
6. 李菲. DRGs 在医院医疗费用支付中的应用研究——基于英国、德国和美国的实证分析. 卫生经济研究, 2019, 36(1): 32-37.
7. 常小婉, 万胜凯, 尼燕, 等. 基于 DRGs 的公立医院控费实践与成效分析. 中国卫生事业管理, 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. 李洪铮, 唐紫君, 薛龙, 等. 疾病诊断相关分组政策实施对三明市公立医院住院服务效率及费用的影响. 中国卫生资源, 2021, 24(4): 393-396, 404.
12. 胡广宇, 刘立煌, 吴世超, 等. 基于间断时间序列分析的 DRG-PPS 改革效果研究. 中国卫生政策研究, 2019, 12(10): 23-28.
13. 王洪彬, 江芹, 张振忠. 按病例组合付费实施效果的实证研究. 中国卫生经济, 2015, 34(7): 17-19.
14. 季新强, 王小艺, 张耀光. 北京医耗联动综合改革对肺癌手术病例住院费用的影响. 中国医院管理, 2022, 42(1): 64-67.
15. 白云, 白玉祥, 潘峰, 等. 基于间断时间序列分析的电子病历实施效果研究. 中国卫生质量管理, 2014, 21(1): 82-85.
16. 陈治水, 冷家骅, 刘忆, 等. 运用间断时间序列分析北京市门诊特种病医保政策实施效果. 中国卫生统计, 2019, 36(1): 141-143.
17. 郎婧婧, 周海龙, 于雪梅, 等. 总额预付改革对住院患者费用控制效果的研究. 中国卫生经济, 2017, 36(2): 20-22.
18. 李超凡, 何佳琳, 杨燕绥. DRGs 支付方式改革前后医院技术效率比较研究——以 F 市为例. 中国卫生事业管理, 2021, 38(9): 641-644.
19. 刘梦灵, 贾明远, 林倩, 等. 取消耗材加成政策对县级公立医院医疗费用结构的影响. 中国卫生经济, 2021, 40(7): 29-32.
20. 吴晶晶, 陈志仙, 张昕男, 等. 江苏省公立医院综合改革效果评价研究——基于间断时间序列分析. 中国卫生事业管理, 2018, 35(3): 163-166.
21. 刘文凤, 玄桂英, 韩梅, 等. 基本医保支付方式内在逻辑关系与改革路径选择. 中国卫生事业管理, 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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