基于双重差分法的DRG付费对中医优势病种住院费用结构及中医特色服务的影响研究OACHSSCD

This study selected inpatients in the anorectal department of a tertiary Grade A inte-grated traditional Chinese and Western medicine hospital in Hefei from January 2020 to August 2024 as the research subjects and divided them into an intervention group and a control group ac-cording to medical insurance type.A Difference-in-Differences(DID)model,the synthetic con-trol method,and a placebo test were used to evaluate the impact of the diagnosis-related groups(DRG)-based payment policy on the average total cost per case,cost structure,and TCM-charac-teristic services among inpatients in TCM hospitals.The results showed that after the implemen-tation of the DRG payment reform,the average total hospitalization cost per case in the interven-tion group decreased significantly by approximately 18.9％(P<0.05),and the out-of-pocket payment ratio also decreased significantly(P<0.05).However,the interaction term coeffi-cients for itemized costs,including general medical service fees,TCM syndrome differentiation and treatment fees,nursing fees,and surgical treatment fees,as well as for indicators reflecting TCM-characteristic services,such as the proportion of TCM medical service costs and the propor-tion of Chinese herbal medicine costs,did not change significantly(P>0.05).The results of the synthetic control method and placebo test further corroborated the reliability of the above core findings.Accordingly,medical insurance authorities should improve the price formation and ad-justment mechanism for TCM services,explore medical insurance payment methods suited to the characteristics of TCM diagnosis and treatment,increase funding,and improve supporting poli-cies and incentive mechanisms,so as to jointly promote cost control and the development of TCM characteristics.