The Cost Control Effect Of The Diagnosis Related Groups(DRGs)

In recent years,China’s health expenditure has grown rapidly,and the proportion of total health expenditure in GDP has increased from 4.9%in 2010 to 6.6%in 2019.The incentive mechanism of relying on medicine to support doctors leads to problems such as over-medical treatment and over-use of medicine,which causes an excessive burden of medical expenditure on the people and reduces the efficiency of the use of medical insurance funds.In order to guide medical institutions to make reasonable treatment and control the excessive growth of medical costs.China began to carry out pilot trials based on disease diagnosis related groups(DRGs)in some regions.In July 2011.Beijing launched and selected six hospitals to carry out the trial work for DRGs.This article uses detailed reimbursement data of urban employees provided by Beijing Social Security Bureau,and uses the effective identification method of event evaluation,difference-in-differences,to evaluate DRGs policy comprehensively.The study found that:First of all,DRGs-based prospective payment policycan effectively reduce the drug costs of patients as a whole,but the effect is poor for the total hospitalization expenses,and the effect of reducing costs is different for different types of patients.Secondly,the internal mechanism is analysed in detail.The results show that the hospital and doctors have made behavioral adjustments to the policy,that is to say,there are cases of shifting the responsibility of patients,especially the patients with serious diseases,and refuse to receive patients.Thirdly,through the heterogeneity analysis of illness,age and departments,it is found that for patients with more serious illness,the policy reform can significantly reduce the total cost of hospitalization,while for patients with less serious illness,the inhibition of the total cost of hospitalization has no effect.For older patients,both hospital costs and drug costs have a more significant inhibitory effect.In addition,the policy effect of different departments is not consistent.Finally,this paper further analyzes the problem of patients’ self-selection.The results show that the estimation results of the subsample excluding transferred patients are similar to the benchmark regression,and the direction is consistent.To sum up,at present,the DRGs trial implementation has not effectively solved the problem of excessively rapid increase in medical expenses.The reason behind this lies in the occurrence of hospitals and doctors’ prevarication on patients and refusal of diagnosis.Therefore,we need to focus on the behavior adjustment of hospitals and doctors,and make response and restrictions on such behavior.