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DRG支付对喀什地区COPD患者住院天数及费用的影响研究
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| 篇名： | DRG支付对喀什地区COPD患者住院天数及费用的影响研究 |
| TITLE： | Impact of DRG payment on length of stay and medical costs in COPD patients from Kashgar region |
| 摘要： | 目的 分析疾病诊断相关分组（DRG）支付方式改革（以下简称“DRG改革”）对喀什地区慢性阻塞性肺疾病（COPD）患者住院天数及费用的影响，为地方医保支付方式优化提供本土化实证依据。方法基于新疆维吾尔自治区医疗保障局的住院结算数据库，选取喀什地区17家医疗机构的COPD住院患者在2022年1月1日至2024年12月31日的结算数据。比较DRG改革前后患者住院天数及费用的整体变化；采用间断时间序列分析（ITSA）方法探究DRG改革对患者的住院天数及费用的影响。结果DRG改革后，患者的平均住院天数及各项费用均较DRG改革前显著下降（P＜0.001）。在整体样本层面，DRG改革后，患者的平均住院天数、次均总费用、次均药品费用、次均医疗服务项目费用、次均检查费用均呈显著的长期下降趋势（P＜0.05），但次均自付费用的下降和次均耗材费的上升趋势无统计学意义（P＞0.05）。三级医疗机构的平均住院天数与各项费用（次均耗材费用除外）在DRG改革后均呈显著的长期上升趋势（P＜0.05）；而二级及以下医疗机构的平均住院天数、次均总费用、次均药品费用、次均医疗服务项目费用、次均检查费用则表现为显著的长期下降趋势（P＜0.05）。结论DRG改革对喀什地区COPD患者整体呈现缩时、控费效果，但不同等级医疗机构的效果存在差异，二级及以下医疗机构住院天数与费用呈长期下降趋势，三级医疗机构则呈现长期上升趋势；患者自付负担未见显著改善。 |
| ABSTRACT： | OBJECTIVE To analyze the impact of the diagnosis-related groups （DRG） payment reform on the length of stay and medical costs in patients with chronic obstructive pulmonary disease （COPD） in Kashgar region， aiming to provide localized empirical evidence for the optimization of regional medical insurance payment methods. METHODS Based on the inpatient settlement database of the Xinjiang Uygur Autonomous Region Healthcare Security Administration， settlement data of COPD inpatients from 17 medical institutions in Kashgar region between January 1， 2022， and December 31， 2024， were extracted. The overall changes in patients’ length of stay and costs were compared before and after the reform. Subsequently， interrupted time series analysis （ITSA） was employed to explore the impact of the DRG payment reform on these variables. RESULTS Following the reform， both the average length of stay and various cost decreased significantly compared to the pre-reform period （ P ＜0.001）. At the overall sample level， the average length of stay， average total cost， average drug cost， average medical service cost， and average examination cost per admission all demonstrated significant long-term downward trends after the reform （ P ＜0.05）. However， the decrease in average out-of-pocket costs and the increase in average consumable costs per admission were not statistically significant （ P ＞0.05）. In tertiary medical institutions， the average length of stay and all categories of costs （except average consumable costs per admission） exhibited significant long-term upward trends after the reform （ P ＜0.05）； conversely， in secondary and lower-level medical institutions， the average length of stay， average total cost， average drug cost， average medical service cost， and average examination cost per admission showed significant long-term downward trends （ P ＜0.05）. CONCLUSIONS The DRG payment reform has achieved an overall effect of reducing the length of stay and controlling costs in COPD patients from Kashgar region. However， the effects vary across different levels of medical institutions： secondary and lower-level institutions show a long-term downward trend in length of stay and costs， whereas tertiary institutions exhibit a long-term upward trend. Furthermore， patients’ out-of-pocket financial burden does not show significant improvement. |
| 期刊： | 2026年第37卷第08期 |
| 作者： | 杨嘉乐；王宁宁；艾则孜江·艾尔肯；连翎凯；吕新一；柳鹏程；姚文兵 |
| AUTHORS： | YANG Jiale，WANG Ningning，Aizezijiang·Aierken，LIAN Lingkai，LYU Xinyi，LIU Pengcheng，YAO Wenbing |
| 关键字： | 慢性阻塞性肺疾病；疾病诊断相关分组；住院天数；住院费用；间断时间序列分析 |
| KEYWORDS： | chronic obstructive pulmonary disease； diagnosis-related groups； length of stay； hospitalization costs； interrupted |
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