按病种付费对住院—门诊服务转移的影响OA

Objective This study attempts to systematically review empirical studies on the shift from inpatient to outpatient services induced by diagnosis-related group(DRG)-based payment reforms,and to provide insights for further deepening medical payment system reform in China.Methods A systematic search was conducted in PubMed,Web of Science,CNKI,Wanfang,and other databases for empirical studies on the shift from inpatient to outpatient services,spanning from database inception to January 1,2025.Two researchers independently screened the literature,extracted data,This study employs descriptive analysis method to conduct qualitative analysis on the included studies.Results A total of 11 studies were included with research periods primarily concentrated in the early stages of payment system reform.Some studies focused on specific diseases or surgical procedures.The main research indicators encompassed three aspects,total volume,costs,and efficiency of inpatient and outpatient services.Particular attention was paid to changes in outpatient service utilization before and after hospital admission and discharge,including outpatient visit rates,frequency,and costs within specific timeframes(e.g.14 days,30 days)before and after admission/discharge.The majority of included empirical studies suggested that DRG-based payment tends to induce a shift from inpatient to outpatient services.From a deeper mechanistic perspective,the institutional structuring capacity of medical insurance payment system reform and the separate payment incentives for inpatient and outpatient services constitute the underlying behavioral drivers.Conclusions The reform of DRG-based payment has influenced the structure of healthcare service utilization and is associated with a risk of shift from inpatient to outpatient care.It is recommended to further advance multi-component medical insurance payment reform,explore innovative outpatient payment strategies,and strengthen dynamic monitoring of service shifting behaviors.