背景:作为医疗机构报销的主要手段,由于特殊的环境和较短的勘探周期,案件支付的效果仍然需要评估,尤其是在中国农村。方法:选择西安市作为干预组,2011年至2013年分别有36,104、48,316和59,087名住院患者。淮滨县作为对照组,有33,073、48,122和51,325名住院患者,分别,从同一时期。住院病人的信息是从当地保险机构收集的。在控制了年龄之后,性别,机构层面,季节固定效果,疾病严重程度,和补偿类型,使用广义累加模型(GAMs)和差异方法(DID)从两个层面(整个县级和每个机构层面)和三个维度(成本、质量和效率)。结果:在全县一级,与对照组相比,干预组的成本相关指标呈现下降趋势.总支出,报销费用和自付费用下降了346.59日元(p<0.001),¥105.39(p<0.001)和¥241.2(p<0.001),分别(符号¥代表人民币)。实际补偿比率,逗留时间,再入院率呈现上升趋势,增加7%(p<0.001),2.18天(p<0.001),和1.5%(p<0.001),分别。县级医院干预组的住院时间减少(¥792.97p<0.001)和再入院率增长(3.3%p<0.001),报销费用减少(¥150.16p<0.001)和住院时间增长(1.24天p<0.001)低于乡镇一级。结论:与简单的定额支付或上限支付相比,升级的案件支付更合理,更适合农村地区。成功遏制了医疗费用的增长,提高了医疗保险基金的使用效率,减轻了患者的疾病经济负担。然而,未观察到对服务质量和效率的积极影响.基层医疗机构的再入院率上升和潜在隐患应引起重视。
Background: As the principal means of reimbursing medical institutions, the effects of
case payment still need to be evaluated due to special environments and short exploration periods, especially in rural China. Methods: Xi County was chosen as the intervention group, with 36,104, 48,316, and 59,087 inpatients from the years 2011 to 2013, respectively. Huaibin County acted as the control group, with 33,073, 48,122, and 51,325 inpatients, respectively, from the same period. The inpatients\' information was collected from local insurance agencies. After controlling for age, gender, institution level, season fixed effects, disease severity, and compensation type, the generalised additive models (GAMs) and difference-in-differences approach (DID) were used to measure the changing trends and policy net effects from two levels (the whole county level and each institution level) and three dimensions (cost, quality and efficiency). Results: At the whole-county level, the cost-related indicators of the intervention group showed downward trends compared to the control group. Total spending, reimbursement fee and out-of-pocket expense declined by ¥346.59 (p < 0.001), ¥105.39 (p < 0.001) and ¥241.2 (p < 0.001), respectively (the symbol ¥ represents Chinese yuan). Actual compensation ratio, length of stay, and readmission rates exhibited ascending trends, with increases of 7% (p < 0.001), 2.18 days (p < 0.001), and 1.5% (p < 0.001), respectively. The intervention group at county level hospital had greater length of stay reduction (¥792.97 p < 0.001) and readmission rate growth (3.3% p < 0.001) and lower reimbursement fee reduction (¥150.16 p < 0.001) and length of stay growth (1.24 days p < 0.001) than those at the township level. Conclusions: Upgraded
case payment is more reasonable and suitable for rural areas than simple quota payment or cap payment. It has successfully curbed the growth of medical expenses, improved the efficiency of medical insurance fund utilisation, and alleviated patients\' economic burden of disease. However, no positive effects on service quality and efficiency were observed. The increase in readmission rate and potential hidden dangers for primary health care institutions should be given attention.