通讯作者: 薛允莲, xueyunlian@163.com

DOI：10.12201/bmr.202603.00043

Impact of DIP Reform on Hospitalization Costs and Structural Changes: An Analysis Based on 12-Year Time-Series Data from Tertiary A Hospitals

• 摘要：目的：探讨按病种分值付费（DIP）改革对患者住院费用及结构的影响，评价改革效果，为医保政策提供参考。方法 基于广州市某三甲医院2013-2024年的数据，构建中断时间序列模型，并结合灰色关联与结构变动分析，多维度剖析DIP改革对住院次均费用及其构成的影响。结果DIP改革有效遏制住院费用快速增长，改革后住院次均总费用（β3）的年增长趋势较改革前下降383.97元（P＜0.001）。药品费用的整体结构变动值最大，且多呈负增长；耗材费用则多呈正增长，是结构变动最主要的正向驱动因素。结论 DIP改革成功控制了住院总费用，促进了“以药养医”转变，费用结构优化初见成效。但耗材费用的补偿性增长成为新挑战。 建议 深化对高值耗材使用的精细化管理和定价，优化DIP支付体系设计、强化多方协同治理以及寻找控费与质量的最优解，推动改革持续优化。

  关键词： DIP; 按病种分值付费; 住院费用; 中断时间序列模型

   

  Abstract: Objective: To explore the impact of the Diagnosis-Intervention Packet (DIP) payment reform on the trends and structure of hospitalization costs, evaluate the effectiveness of the reform, and provide empirical references for medical insurance policy adjustments. Methods: Based on hospitalization cost data from a tertiary grade-A hospital in Guangzhou from 2013 to 2024, an interrupted time series model was constructed. Combined with grey relational analysis and structural variation analysis, the impact of the DIP reform on average hospitalization costs per visit and their internal composition was analyzed from multiple dimensions. Results: The DIP reform effectively curbed the rapid growth of hospitalization costs. After the reform, the annual growth trend of the average total hospitalization cost per visit (β_3) decreased by 383.97 CNY compared to the pre-reform period (P＜0.001). The structural variation value of drug costs was the largest, showing negative growth in most years; conversely, consumable costs showed positive growth in most years, serving as the primary positive driving factor for structural variation. Conclusion: The DIP reform has successfully achieved control over total hospitalization costs and promoted the transformation of the nourishing medicine with drugs mechanism, with initial success seen in cost structure optimization. However, the compensatory growth of consumable costs has emerged as a new challenge. Recommendations: It is suggested to deepen the refined management and pricing of high-value consumables, optimize the design of the DIP payment system, strengthen multi-party collaborative governance, and seek the optimal balance between cost control and quality to promote the continuous optimization of the DIP reform.

  Key words: DIP; Hospitalization expenses; Interrupted time series; 

  提交时间：2026-03-11

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  2	2025-10-31	10.12201/bmr.202603.00043V2	下载
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