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Objective:To analyze the effect of the implementation of diagnosis-intervention packet (DIP) on the doctors′ diagnosis and treatment behavior of chronic diseases, so as to provide reference for further improving medical insurance payment related policies.Methods:The first page information of chronic disease patients admitted to hospitals with diabetes, hypertension and coronary atherosclerotic heart disease as the main conditions in 103 hospitals at all levels and township health centers in a city from 2016 to 2020 was collected, and the patients were divided into non-DIP group and DIP group according to the implementation time of DIP. After 1∶1 propensity score matching to balance the general conditions of the 2 groups, the diagnosis and treatment behaviors were analyzed from two dimensions: diagnostic behavior and treatment behavior. The grade A rate of medical record writing, admission and discharge diagnosis coincidence rate, and the average length of stay were used to evaluate the diagnostic behavior; the proportion of drugs and the degree of change in the cost structure were used as the evaluation indicators of treatment behavior.Results:After matching, 41 050 patients were included in both the non-DIP group and the DIP group.From the perspective of diagnostic behavior, the grade A rate of medical record writing in the non-DIP group and the DIP group was 99.40% and 99.83%, the coincidence rate of admission and discharge diagnosis was 58.42% and 61.79%, the average hospital stay was 8.03 days and 7.04 days respectively, and the difference between the groups was significant ( P<0.05). From the view of treatment behavior, the proportion of drugs decreased from 33.00% in the non-DIP group to 27.59% in the DIP group, with a significant difference ( P<0.05); the drug cost represented by Western medicine changed negatively, while the diagnostic cost showed a positive change. Conclusions:DIP has played a certain role in regulating doctors′ diagnosis and treatment behavior for chronic diseases. Among them, doctors have significantly improved their diagnostic behavior for chronic diseases, and the proportion of drugs in treatment behavior has been well controlled.
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Objective:To explore the change trend of average hospitalization expense and cost structure of inpatients after the implementation of diagnosis-intervention packet (DIP) payment reform in Zhuhai.Methods:The data of hospitalization expense and the proportion of each classification cost (i.e. the value of a classification cost per thousand yuan of medical cost) in Zhuhai before and after the reform were analyzed by interrupted time series method, and the changes of per capita hospitalization cost and cost structure were studied.Results:The average hospitalization expense showed a linear change trend before and after the reform, and the immediate level and the slope of regression line did not change significantly after the reform, which was basically consistent with the trend before the reform. After the implementation of DIP, the proportion of various categories of expenses changed. Among them, the proportion of comprehensive medical services, treatment, traditional Chinese medicine, western medicine, blood and blood products, and other categories changed significantly, P values were less than 0.05. There was no obvious change in the proportion of expenses of diagnosis, rehabilitation and traditional Chinese medicine, but there was a change in the immediate level. The change in the level of diagnosis was -13.649 ( P< 0.001), the change in the level of rehabilitation was -1.053 ( P< 0.001), and the change in the level of traditional Chinese medicine was 2.781 ( P< 0.001). The immediate level and trend change of the proportion of consumables after the reform was not obvious. Conclusions:After the implementation of DIP payment in Zhuhai, the average expense of inpatients has not changed significantly, but the expense structure has changed significantly.
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The reform of medical insurance payment system could promote the transformation of medical services from price medical care to value medical care, which is very important to promote the construction of medical alliance. The authors discussed the reform of medical insurance payment system to promote the construction of medical alliance, and the order of medical alliance covering medical services and seeking medical treatment.For medical service providers, the reform of medical insurance payment system helped to promote the construction of closer medical alliance, guided the sinking of high-quality resources, helped to form a smooth referral mechanism, and strengthened the supervision and assessment of medical behavior. For the demanders of medical services, the differentiated medical insurance reimbursement proportion policy within the medical alliancewas more conducive to attracting the first consultation at the grass-roots level. At the same time, patients had a wider choice of medical treatment and more freedom of choice. In view of the problems existing in practice, the authors suggested that a variety of medical insurance payment and performance systems with value-based medical care as the core should be implemented to deepen the development of medical alliance, the medical insurance system and municipal subsidies should jointly undertake the salary subsidies for sinking medical personnel, and integrate the grass-roots fragmented health care business with the help of medical insurance payment tools, and promote the coverage expansion of the medical insurance reform of the medical alliance based on policy guidance.
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One of the challenges to diagnosis-intervention packet is how to detect and avoid the institutional behavior of pursuing a higher score group. Based on the analysis method of big data, the authors analyzed the objective distribution characteristics of the treatment methods corresponding to a diagnosis, and compared the distribution of diseases with high and low scores in the region to find out the selection trend of treatment methods for the same diagnosis in various hospitals. Combined with hospital positioning, the authors found out whether there was a tendency of pursuing a higher score group. Scientific support will be provided for the reasonable payment of medical insurance expenses and the development planning of hospitals.
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Objective:To explore the price formation method and price standard in the big data diagnosis-intervention packet.Methods:The expenditure data and income data of 95 medical institutions in Shanghai in 2018 were used for analysis, including 33 municipal hospitals and 62 district hospitals. After using the standardized data of disease score, the medical institutions in the region were divided into four quadrants with the regional average of unit price per index and cost per index as the coordinate axis. The best quadrant of income and cost was found out, namely the high quality range. The geometric center was calculated in the high quality range, and the unit price per index of the geometric center was taken as the cost standard.Results:For the district hospitals, there were 20 hospitals in the first quadrant, 8 in the second quadrant, 24 in the third quadrant and 10 in the fourth quadrant; For the municipal hospitals, there were 7 hospitals in the first quadrant, 5 in the second quadrant, 12 in the third quadrant and 9 in the fourth quadrant. In the third quadrant, the average income and cost of medical institutions were lower than the average of the city, and the income could cover the cost. The third quadrant was the high quality range. The unit price per index of the third quadrant geometric center of district hospitals was 14 115.4 yuan, and that in municipal hospitals was 15 559.1 yuan, which could be used as the corresponding cost standard.Conclusions:The price discovery mechanism based on objective data and high-quality interval geometric center method can remove the impact of unreasonable charges or unreasonable behavior on medical income, and reflect the guidance of the standard price of medical insurance payment.
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Medical insurance payment model is transforming from project-based purchases to service bundle-based strategic purchases. The new form of bundled purchases should found on a scientifically-led design process of such bundles. The core to bundled purchase would be the payment standard, and the key to its success would be process control. Establishment of such a foundation, a core, and a key, would promote the current price standards, and lead service providers to a standardized medical service standard, so as to ensure a precise rewarding system of payment and service. The big data diagnosis-intervention packet(DIP)is able to fulfill mentioned ambitions by integrating insurance payment and supervision into one management. DIP is a full-process payment mode that encompasses pre-service estimation, in-service process control, post-service grading, and resource allocation. It is an innovative practice in line with China′s national conditions for the modern governance of medical security and medical services.