基于傾向性評分匹配的疾病診斷相關分組支付方式下江蘇省某兒童醫院再生障礙性貧血患者住院費用的控費效果
首發時間：2025-10-17
沈林羽（1999-），女，主要研究方向：醫療保險和衛生管理
馬亞娜 1馬亞娜（1968-），女，副教授、碩導，主要研究方向：社區健康管理.
摘要：目的評估疾病診斷相關分組付費改革對江蘇省某三甲兒童醫院2021年1月-2023年12月收治的再生障礙性貧血患者住院費用的控費效果，并分析疾病診斷相關分組編碼對醫保外自付比例的影響。方法收集符合條件的809例患者數據，其中疾病診斷相關分組付費組112例，傳統付費組697例。本研究創新性地將傾向性評分匹配法應用于血液系統非手術慢性病的疾病診斷相關分組控費效果評估，平衡兩組基線差異后，借助Wilcoxon秩和檢驗對比組間費用差異；首次采用Beta回歸模型深入分析不同疾病診斷相關分組編碼對患者自付比例的異質性影響，以醫保外自付比例為因變量，分組編碼為自變量。結果經傾向性評分匹配后納入336例患者（疾病診斷相關分組付費組112例，傳統付費組224例），疾病診斷相關分組付費組醫療總費用中位數為7013.54元，顯著低于傳統付費組的11481.16元（P<0.05）；西藥費、化驗費等明細費用組間差異顯著（P<0.05）。Beta回歸顯示，不同疾病診斷相關分組編碼對醫保外自付比例影響存在顯著異質性（P<0.05），QS35分組的邊際效應最高（0.2206），QQY分組次之（0.3757）。結論本研究填補了疾病診斷相關分組付費改革在兒童血液系統疾病領域的研究空白，證實疾病診斷相關分組付費對再生障礙性貧血患者住院費用有顯著控費效果，但不同分組自付比例的異質性提示需優化分組策略，為兒童專科醫院精準支付政策制定提供了實證依據。
關鍵詞： 疾病診斷相關分組付費改革 再生障礙性貧血 住院費用 傾向性評分匹配 Beta回歸 醫療保障。
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The Cost Control Effect of Hospitalization Expenses for Aplastic Anemia Patients in a Children\'s Hospital in Jiangsu Province under the DRG Payment Method Based on PSM
沈林羽（1999-），女，主要研究方向：醫療保險和衛生管理
Ma YaNa 1馬亞娜（1968-），女，副教授、碩導，主要研究方向：社區健康管理.
Abstract：Objective To evaluate the cost control effect of the Diagnosis-Related Groups (DRG) payment reform on the hospitalization costs of aplastic anemia patients admitted to a tertiary hospital in Jiangsu Province from January 2021 to December 2023, and to analyze the impact of DRG group coding on out-of-pocket expenses outside of health insurance. Methods Data from 809 eligible patients were collected, including 112 in the DRG group and 697 in the non-DRG group. This study innovatively applied propensity score matching (PSM) to evaluate the cost control effect of DRG on non-surgical chronic hematological diseases, , balancing baseline differences between the two groups, and Wilcoxon rank sum test was employed to compare cost differences; For the first time, a Beta regression model was used to deeply analyze the heterogeneous impact of different DRG group codes on patients\' out-of-pocket ratios, with out-of-pocket expenses as the dependent variable and DRG group coding as the independent variable. Results After PSM, 336 patients were included (112 in the DRG group and 224 in the non-DRG group). The median total medical expense in the DRG group was 7013.54 yuan, significantly lower than the 11481.16 yuan in the non-DRG group (P<0.05); there were significant differences in detailed expenses such as Western medicine costs and laboratory fees between the two groups (P<0.05). Beta regression showed that different DRG group codes had a significant impact on out-of-pocket expenses outside of health insurance (P<0.05), with the highest marginal effect observed in the QS35 group (0.2206). Conclusion This study fills the research gap of DRG payment reform in pediatric hematological diseases, confirming that DRG has a significant cost control effect on hospitalization costs of aplastic anemia patients. However, the heterogeneity of out-of-pocket ratios among different DRG groups suggests the need for optimized grouping strategies, providing empirical evidence for formulating precise DRG payment policies in children\'s specialty hospitals.
Keywords： DRG payment reform aplastic anemia hospitalization costs propensity score matching Beta regression Medical coverage
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基于傾向性評分匹配的疾病診斷相關分組支付方式下江蘇省某兒童醫院再生障礙性貧血患者住院費用的控費效果
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