关键词: 结核,肺, 住院病人, 费用,医疗, 卫生政策, 预期支付系统

Abstract:

Objective: To comprehensively analyze the impact of the Diagnosis Related Groups (DRG) payment method on the treatment costs of inpatients with pulmonary tuberculosis, and provide scientific evidence to support policy formulation. Methods: A retrospective study was conducted including 20369 patients primarily diagnosed with pulmonary tuberculosis and admitted to Beijing Chest Hospital, Capital Medical University from June 15, 2017, to June 14, 2024. Taking the implementation of DRG in 2022 as the time cut-off, patients were divided into a pre-implementation group (n=11653) and a post-implementation group (n=8716). A difference-in-differences (DID) model was applied to control for variables such as age, gender, and length of hospital stay, so as to analyze the net effect of the DRG policy. Additionally, the parallel trend test was conducted to verify the model assumptions. Results: Following the implementation of DRG, the hospital days of the patient was decreased from 12 d to 6 d. The median total hospitalization cost of patients was 16588.04 yuan, representing an 18.88% reduction compared with the pre-implementation period (20411.17 yuan). Specifically, drug costs decreased by 60.07% ((2801.14-7015.36)/7015.36), treatment costs decreased by 14.77% ((804.75-944.20)/944.20), while examination costs increased slightly by 1.83% ((1066.20-1047.00)/1047.00). These differences before and after the implementation were statistically significant (U=-51.354, P<0.001; U=-25.708, P<0.001; U=-42.403, P<0.001; U=-17.628, P<0.001; U=-3.106, P=0.002). The parallel trend test confirmed the presence of a policy effect. The DID model further indicated that the net effect of the policy significantly reduced total costs, examination costs, treatment costs, and drug costs by 32.20%, 52.80%, 48.00%, and 36.80% respectively. Conclusion: The DRG payment reform substantially reduced the length of hospital day and hospitalization costs of patients with pulmonary tuberculosis, with particularly prominent effects on drug and treatment costs. These finding highlight the positive role of prospective payment system in controlling medical costs, alleviating patient financial burden, and improving the efficiency of medical insurance funds, thereby providing empirical evidence to support payment reforms in tuberculosis prevention and control. Nevertheless, attention should be paid to structural changes in examination costs, and further efforts are needed to refine grouping criteria and optimize diagnostic processes.

Key words: Tuberculosis, pulmonary, Inpatients, Fees, medical, Health policy, Prospective payment system