Effect Of Diagnosis-Intervention Packet Policy On Medical Burden And Drug Use Of Patients With Cerebrovascular Disease

Diagnosis-Intervention Packet(DIP)is an original medical insurance payment method for controlling medical insurance fees in China.This paper aims to study the influence of DIP on the medical burden and drug use of patients with cerebrovascular diseases,and discuss how to carry out pharmaceutical management under DIP policy to help control medical insurance fees,so as to provide reference for reducing patients’medical burden and finely managing medical institutions.Firstly,the patients with cerebrovascular diseases discharged from a large 3A hospital in Guangzhou from July 15,2017 to March 31,2019 were selected,and the influencing factors of hospitalization expenses of patients with cerebrovascular diseases were analyzed by single factor analysis and multiple linear regression.Differences-in-Differences method was used to establish the net effect model of patients’ hospitalization cost and drug cost to evaluate the implementation effect of DIP,and then grouped and analyzed based on different classification methods.Secondly,the Guangzhou medical insurance patients with cerebrovascular diseases discharged from the hospital from 2019 to 2021 were selected,and the structural change analysis method was used to observe the structural changes of hospitalization expenses after the implementation of DIP.Finally,the potential impact of DIP policy on drug use and pharmaceutical management under DIP policy are discussed.The results showed that:1.The factors affecting the hospitalization cost of patients with cerebrovascular disease under DIP policy in descending order were the number of days of hospitalization,the risk level by Diagnosis Related Groups(DRG),discharge mode,gender,age and admission route.The longer the number of days in hospital the higher the cost of hospitalization for patients,the higher the cost of hospitalization for patients with higher DRG risk class,the higher the cost of hospitalization for patients who died,the higher the cost of hospitalization for female patients,and the higher the cost of hospitalization for patients aged 45 years and younger,and the higher the cost of hospitalization for patients whose route of admission was a transfer from another healthcare facility.2.Overall,the total cost of hospitalization for patients with cerebrovascular disease in this hospital decreased significantly after the implementation of DIP.The cost of hospitalization,drugs and western medicine in the difficult case group decreased significantly;the cost of drugs and western medicine in the operation group decreased significantly;the cost of western medicine in the group of patients with hemorrhagic cerebrovascular disease decreased significantly,and the total cost of hospitalization in the group of patients with other cerebrovascular diseases decreased significantly.3.The cost of drugs and consumables was the main cost that caused the change in the structure of hospitalization cost of patients with cerebrovascular diseases.The potential impact of DIP policy on drug use is to reduce the use of complementary drugs,promote the use of low-cost drugs instead of highcost drugs,and improve the motivation of medical staff to optimize the cost structure.The potential impact of DIP policy on drug use is to reduce the use of adjuvant drugs,promote the use of low-cost drugs instead of high-cost drugs,shift drug costs,and limit the development of drug innovation.From the perspective of medical institutions,DIP policy can force them to manage themselves.From the perspective of health insurance operators,DIP policy can ensure the sustainability of health insurance funds.From the perspective of patients,DIP policy can reduce the medical burden of patients.Therefore,the DIP policy can achieve a win-win situation for doctors,insurers and patients.under the new situation of DIP reform,hospital pharmacy enters a critical period of transformation,and medical institutions should strengthen pharmacy management,including building a pharmacy service system under DIP,formulating and regularly adjusting DIP drug catalogs and standardizing clinical pathways.