DRG付费对住院前门诊医疗服务的影响研究OA

Objective To examine the changes in outpatient medical service utilization and costs before hospitalization among pa-tients with chronic ischemic heart disease after the implementation of DRG payment system in City H,explore the impact of DRG pay-ment on outpatient medical services,and provide a reference for further improving medical insurance payment reform.Methods Using medical insurance claims data for hypertensive and diabetic patients with chronic ischemic heart disease in City H from 2019～2020,in-terrupted time series analysis was employed to evaluate changes in hospitalization service,outpatient medical service before hospitaliza-tion,and episode treatment costs before and after DRG implementation.Results Following DRG adoption,the average total hospitaliza-tion cost decreased immediately after the reform(β2=-0.080,P<0.05),while length of stay remained unchanged.Visits and costs of pre-admission outpatient service increased significantly,particularly in secondary and tertiary hospitals.Total treatment episode costs showed no significant variation.Conclusion After the implementation of DRG-based payment,inpatient services may shift to the pre-admission outpatient setting,highlighting the need for better outpatient management and payment reforms.