Study On The Effectiveness Of DRG Payment Reform Based On The Difference-in-difference Method

Objective:On the basis of systematically sorting out the relevant literatures and policy researches of DRG payment reform on hospitalization expenses and hospitalization days,this study made a comparative analysis on the differences in hospitalization expenses and hospitalization days of insured patients before and after DRG payment reform,and took a tertiary general hospital in Shanxi Province as an example to explore the regulation effect of DRG payment reform on the hospitalization expenses and hospitalization days of insured patients,based on the background of policy implementation in sample area and the results of empirical research and analysis,the reasons for the differences were analyzed and discussed,which provides a theoretical basis for the operation of medical institutions and the deepening of DRG payment reform in sample area.Methods:1.Literature research method:Through consulting and studying relevant works and dissertations at home and abroad,understand the implementation status and research progress of DRG payment reform at home and abroad,and provide theoretical basis and suitable research methods for this study.2.Statistical methods:Statistical description: the indicators of the implementation effect of DRG payment reform are mainly described by mean value,standard deviation,percentage,etc;Parameter test: use the t-test method to conduct parallel trend test(The assumption that sample data need to satisfy when using the difference-in-differences method to evaluate policy effects).3.Difference-in-Differences Method:In this study,select local insured patients as the experimental group,and other patients in the same period are used as the control group.Construct the difference-in-difference model to analyze the implementation effect of the DRG payment reform in the hospital.Stata 15.0 is used for statistical analysis of the data.Results:1.After the implementation of DRG payment,the total number of discharged patients,the total hospitalization expenses,and the 31-day re-hospitalization rate increased,while the per capita hospitalization expenses and the average hospitalization days showed a downward trend.The qualified rate of medical records did not change significantly;the proportion of service expenses and diagnosis expenses increased in the composition of expenses,while the proportion of treatment expenses,drug expenses and material expenses decreased.2.Before and after the implementation of DRG,the majority of patients in this department were elderly people around 60 years old.The average hospitalization expenses of male patients was higher than that of female patients,which conformed to the epidemiological characteristics of cardiovascular diseases.The average hospitalization expenses of acute myocardial infarction among cardiovascular diseases before and after the implementation of DRG was the highest,and the average hospitalization expenses of surgical patients was higher than that of non-surgical patients.3.The difference-in-difference regression model showed that after adding control variables(gender,age,disease type and operation or not)to the model,the results were consistent with the original results and the results were robust.Compared with the patients in the control group who were not included in the DRG payment,the implementation of the DRG payment reform still had a significant impact on the total hospitalization expenses,service expenses,diagnosis expenses,treatment expenses and actual hospitalization days of the insured patients in the experimental group.which reduced the total hospitalization expenses,diagnosis expenses,treatment expenses and actual hospitalization days of the patients in the department by 5.5%,2.6%,44.8% and 3.3% respectively,the service expenses increased by 10.8%,the impact on material expenses was still not statistically significant.This study chose the evaluation index(drug expenses)that is less affected by the DRG payment reform to conduct a robustness test.The results showed that the drug expenses of inpatients in cardiovascular medicine department increased after the implementation of DRG policy,but there was no statistical significance(P >0.1).The regression results before and after adding control variables were not significant,indicating that the results of this study were robust.Conclusions:1.In this study,the comparative analysis results before and after the implementation of DRG payment reform show that the implementation of the policy has received certain effects.In the context of the general rise of medical and health expenses,the per capita hospitalization expenses and the average hospitalization days have decreased significantly.The cost structure is more reasonable,but there is still room for improvement.2.The difference-in-difference results show that the implementation of DRG payment reform has reduced the total hospitalization expenses,diagnostic expenses,treatment expenses,and actual hospitalization days of insured patients in the experimental group to varying degrees,and the reform has achieved certain cost control effects;The control effect of material expenses needs to be improved;Significantly increasing service expenses and reflecting the value of medical personnel’s technical services;It indicates that it has certain superiority in controlling the unreasonable growth of medical expenses and regulating medical service behavior.It reflects the scientific nature of the overall design of the National Medical Insurance Bureau and also proves that the sample region has good adaptability to the DRG payment reform.