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Article(id=1240395011062297453, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202503240, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1741795200000, receivedDateStr=2025-03-13, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773662816062, onlineDateStr=2026-03-16, pubDate=1753372800000, pubDateStr=2025-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773662816062, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773662816062, creator=13701087609, updateTime=1773662816062, updator=13701087609, issue=Issue{id=1240395006914130733, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773662815073, creator=13701087609, updateTime=1773662858015, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240395187109810535, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240395187109810536, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2575, endPage=2581, ext={EN=ArticleExt(id=1240395011330732931, articleId=1240395011062297453, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Heterogeneous impacts of diagnosis - intervention packet policy on high/low complexity cases, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the heterogeneous effects of Diagnosis-Intervention Packet (DIP) payment reform on the quantity distribution and cost patterns of high/low-complexity cases (measured by Case Mix Index, CMI), and to reveal hospital hierarchical response mechanisms under cost-control pressures, thereby providing policy recommendations.

Methods

Using three-year pre-and post-DIP pilot data (2018-2023), we constructed a difference-in-differences (DID) fixed-effects model with medical insurance patients as the treatment group and non-insured patients as the control group. The model incorporated diagnosis-related group (DRG) fixed effects and a policy×high-CMI interaction term to quantify heterogeneous impacts across complexity levels.

Results

The DIP policy significantly reduced per-case medical costs (β3=-803.570, P<0.001), per-case medical service costs (β3=-128.434, P=0.019), and per-case material costs (β3=-290.519, P<0.001) in the treatment group, alongside a reduction in the absolute deviation from the mean by 228.644 CNY (P=0.016) and a shortened average length of stay by 1.080 days (P<0.001). Stratified by CMI, high-CMI cases exhibited additional reductions in per-case costs (β3=-309.400), material costs (β3=-549.843), and hospitalization days (β3=-0.715) compared to low-CMI cases, yet showed an increase in per-case medical service costs (β3=273.834).

Conclusion

Hospitals adopted distinct response mechanisms under DIP-driven cost constraints. For high-CMI cases, cost control was achieved through technology-for-materials substitution (prioritizing technical service income while reducing material expenditures), whereas low-CMI cases relied on comprehensive cost suppression.These findings highlight the need for complexity-tiered payment adjustments to balance cost containment and care quality.

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目的

探讨病种分值付费（DIP）支付改革对高/低复杂度（CMI）病例在数量分布与费用情况上的异质性影响，揭示医院在控费压力下的分层响应机制并建议。

方法

基于DIP试点前后三年数据（2018—2023年），以医保患者作为实验组，其他患者作为对照组，构建双重差分固定效应模型（DID），并在模型中构建病种固定效应与政策×高CMI交互项，量化政策对高/低复杂度病例的异质性影响。

结果

DIP政策显著降低了实验组患者的次均医疗费用（β3=-803.570，P<0.001）与次均医疗服务费用（β3=-128.434，P=0.019），次均耗材费用（β3=-290.519，P<0.001），离均差绝对值降低228.644元（P=0.016），缩短平均住院日1.080天（P<0.001）。分CMI来看，高CMI病例占比降低，相较低CMI病例，高CMI病例次均费用、次均耗材费用、平均住院日等均有额外的降低效应，分别降低309.400元，549.843元，0.715天；次均医疗服务费用反而增长273.834元。

结论

医院在DIP政策压力下对不同CMI病例的响应机制不完全相同，高CMI病例的费用管控空间更大，医院对高CMI病例通过“以技代材”（提升手术技术收入、压缩检查耗材）实现控费，而对低CMI病例依赖全面成本压制。

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潘杰，E-mail：
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罗毓灵（1995—），女，硕士在读，研究方向：统计方法与应用

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Chinese Health, 2020, (12): 53-54. (In Chinese), articleTitle=Huai ’an, Jiangsu: The first mover’s attempt and exploration, refAbstract=null), Reference(id=1240413549596561807, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2024, volume=41, issue=1, pageStart=80, pageEnd=83, url=null, language=null, rfNumber=［2］, rfOrder=2, authorNames=金琦, 吴双赢, 代婷婷, journalName=中国卫生统计, refType=null, unstructuredReference=金琦，吴双赢，代婷婷，等．基于结构方程模型的广东省人均卫生费用影响因素研究[J].中国卫生统计，2024,41(1):80-83., articleTitle=基于结构方程模型的广东省人均卫生费用影响因素研究, refAbstract=null), Reference(id=1240413549747556757, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2024, volume=41, issue=1, pageStart=80, pageEnd=83, url=null, language=null, rfNumber=［2］, rfOrder=3, authorNames=Jin Q, Wu SY, Dai TT, journalName=Chinese Journal of Health Statistics, refType=null, unstructuredReference=Jin Q, Wu SY, Dai TT, et al.Study on the influencing factors of per capita health expenditure in Guangdong Province based on structural equation model[J]. Chinese Journal of Health Statistics, 2024, 41(1): 80-83. (In Chinese), articleTitle=Study on the influencing factors of per capita health expenditure in Guangdong Province based on structural equation model, refAbstract=null), Reference(id=1240413549936300443, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2024, volume=17, issue=5, pageStart=17, pageEnd=24, url=null, language=null, rfNumber=［3］, rfOrder=4, authorNames=林坤河, 上官业声, 饶娅琦, journalName=中国卫生政策研究, refType=null, unstructuredReference=林坤河，上官业声，饶娅琦，等．DIP支付方式下医保供给侧政策协同对费用控制的影响研究[J].中国卫生政策研究，2024,17(5):17-24., articleTitle=DIP支付方式下医保供给侧政策协同对费用控制的影响研究, refAbstract=null), Reference(id=1240413550045352355, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2024, volume=17, issue=5, pageStart=17, pageEnd=24, url=null, language=null, rfNumber=［3］, rfOrder=5, authorNames=Lin KH, Shang Guan YS, Rao YQ, journalName=Chinese Journal of Health Policy, refType=null, unstructuredReference=Lin KH, Shang Guan YS, Rao YQ, et al. Research on theimpact of supply side policy coordination of medical insurance on cost control under Dip payment method[J]. Chinese Journal of Health Policy, 2024, 17(5): 17-24. (In Chinese), articleTitle=Research on theimpact of supply side policy coordination of medical insurance on cost control under Dip payment method, refAbstract=null), Reference(id=1240413550162792874, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=40, issue=2, pageStart=69, pageEnd=73, url=null, language=null, rfNumber=［4］, rfOrder=6, authorNames=黄小红, 李云峰, 杨业春, journalName=卫生经济研究, refType=null, unstructuredReference=黄小红，李云峰，杨业春．相关医改政策的控费效果评价研究——基于“药品零加成”“耗材零加成”和“按病种分值付费”[J].卫生经济研究，2023,40(2):69-73., articleTitle=相关医改政策的控费效果评价研究——基于“药品零加成”“耗材零加成”和“按病种分值付费”, refAbstract=null), Reference(id=1240413550267650480, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=40, issue=2, pageStart=69, pageEnd=73, url=null, language=null, rfNumber=［4］, rfOrder=7, authorNames=Huang XH, Li YF, Yang YC, journalName=Health Economics Research, refType=null, unstructuredReference=Huang XH, Li YF, Yang YC. Evaluation of cost control effect of relevant medical reform policies: based on canceling drug price addition,canceling medical consumable addition and Diagnosis-Intervention packet[J]. Health Economics Research, 2023, 40(2): 69-73. (In Chinese), articleTitle=Evaluation of cost control effect of relevant medical reform policies: based on canceling drug price addition,canceling medical consumable addition and Diagnosis-Intervention packet, refAbstract=null), Reference(id=1240413550364119478, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=null, issue=12, pageStart=84, pageEnd=89, url=null, language=null, rfNumber=［5］, rfOrder=8, authorNames=王春雨, 陈维雄, journalName=中国医疗保险, refType=null, unstructuredReference=王春雨，陈维雄．DIP实施前后患者住院费用结构变化的实证研究——以广东省10家公立医院为例[J].中国医疗保险，2023,(12):84-89., articleTitle=DIP实施前后患者住院费用结构变化的实证研究——以广东省10家公立医院为例, refAbstract=null), Reference(id=1240413550502531517, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=null, issue=12, pageStart=84, pageEnd=89, url=null, language=null, rfNumber=［5］, rfOrder=9, authorNames=Wang CY, Chen WX, journalName=China Health Insurance, refType=null, unstructuredReference=Wang CY, Chen WX. An empirical study on the change of inpatient cost structure before and after the implementation of Dip policy——taking ten public hospitalsin Guangdong province as an example[J]. China Health Insurance, 2023, (12): 84-89. (In Chinese), articleTitle=An empirical study on the change of inpatient cost structure before and after the implementation of Dip policy——taking ten public hospitalsin Guangdong province as an example, refAbstract=null), Reference(id=1240413550603194818, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2012, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=［6］, rfOrder=10, authorNames=Iezzoni L, journalName=Risk adjustment for measuring health care outcomes, refType=null, unstructuredReference=Iezzoni L. Risk adjustment for measuring health care outcomes[M]. 4th ed. Chicago: Health Administration Press, 2012., articleTitle=null, refAbstract=null), Reference(id=1240413550741606855, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2020, volume=37, issue=6, pageStart=30, pageEnd=32, 14, url=null, language=null, rfNumber=［7］, rfOrder=11, authorNames=李菊红, 周林玉, 陈灵峰, journalName=医院管理论坛, refType=null, unstructuredReference=李菊红，周林玉，陈灵峰．CMI在促进医疗服务能力提升的作用研究[J].医院管理论坛，2020,37(6),30-32, 14., articleTitle=CMI在促进医疗服务能力提升的作用研究, refAbstract=null), Reference(id=1240413550829687243, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2020, volume=37, issue=6, pageStart=30, pageEnd=32, 14, url=null, language=null, rfNumber=［7］, rfOrder=12, authorNames=Li JH, Zhou LY, Chen LF, journalName=Hospital Operation, refType=null, unstructuredReference=Li JH, Zhou LY, Chen LF. Research on CMI and its role in promoting medical service capabilities[J]. Hospital Operation, 2020, 37(6): 30-32, 14. (In Chinese), articleTitle=Research on CMI and its role in promoting medical service capabilities, refAbstract=null), Reference(id=1240413550892601807, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2022, volume=29, issue=7, pageStart=58, pageEnd=61, url=null, language=null, rfNumber=［8］, rfOrder=13, authorNames=丁磊, 左安俊, 蒋光峰, journalName=中国卫生质量管理, refType=null, unstructuredReference=丁磊，左安俊，蒋光峰，等．病例组合指数的内涵及应用探讨[J].中国卫生质量管理，2022,29(7):58-61., articleTitle=病例组合指数的内涵及应用探讨, refAbstract=null), Reference(id=1240413551001653715, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2022, volume=29, issue=7, pageStart=58, pageEnd=61, url=null, language=null, rfNumber=［8］, rfOrder=14, authorNames=Ding L, Zuo AJ, Jiang GF, journalName=Chinese Health Quality Management, refType=null, unstructuredReference=Ding L, Zuo AJ, Jiang GF, et al. The connotation and application of the case combination index[J]. Chinese Health Quality Management, 2022, 29(7): 58-61. (In Chinese), articleTitle=The connotation and application of the case combination index, refAbstract=null), Reference(id=1240413551098122712, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2022, volume=15, issue=7, pageStart=8, pageEnd=15, url=null, language=null, rfNumber=［9］, rfOrder=15, authorNames=李秋莎, 杨春晓, 赵兹旋, journalName=中国卫生政策研究, refType=null, unstructuredReference=李秋莎，杨春晓，赵兹旋，等．我国按病种分值付费（DIP）政策研究——基于国家、省、市三级的比较分析[J].中国卫生政策研究，2022,15(7):8-15., articleTitle=我国按病种分值付费（DIP）政策研究——基于国家、省、市三级的比较分析, refAbstract=null), Reference(id=1240413551223951836, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2022, volume=15, issue=7, pageStart=8, pageEnd=15, url=null, language=null, rfNumber=［9］, rfOrder=16, authorNames=Li QS, Yang CX, Zhao ZX, journalName=Chinese Journal of Health Policy, refType=null, unstructuredReference=Li QS, Yang CX,Zhao ZX, et al. Research on the policy of Diagnosis-Intervention Packet (DIP) in China: A comparative analysis based on the national, provincial and municipal levels[J]. Chinese Journal of Health Policy, 2022, 15(7): 8-15. (In Chinese), articleTitle=Research on the policy of Diagnosis-Intervention Packet (DIP) in China: A comparative analysis based on the national, provincial and municipal levels, refAbstract=null), Reference(id=1240413551312032226, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=14, issue=18, pageStart=45, pageEnd=49, url=null, language=null, rfNumber=［10］, rfOrder=17, authorNames=李淑艳, 张红, 苏凌璎, journalName=中国卫生标准管理, refType=null, unstructuredReference=李淑艳，张红，苏凌璎，等．基于DIP下医院病种管理的现状及新型病种管理策略[J].中国卫生标准管理，2023,14(18):45-49., articleTitle=基于DIP下医院病种管理的现状及新型病种管理策略, refAbstract=null), Reference(id=1240413551425278434, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=14, issue=18, pageStart=45, pageEnd=49, url=null, language=null, rfNumber=［10］, rfOrder=18, authorNames=Li SY, Zhang H, Su LY, journalName=China Health Standard Management, refType=null, unstructuredReference=Li SY, Zhang H, Su LY, et al. Current situation and new disease management strategies of hospital disease management based on Dip[J]. China Health Standard Management, 2023, 14(18): 45-49. (In Chinese), articleTitle=Current situation and new disease management strategies of hospital disease management based on Dip, refAbstract=null), Reference(id=1240413551534330343, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=44, issue=19, pageStart=17, pageEnd=19, url=null, language=null, rfNumber=［11］, rfOrder=19, authorNames=吴月苹, 李红娟, 张亮, journalName=医学与哲学, refType=null, unstructuredReference=吴月苹，李红娟，张亮，等．医保DIP改革与医疗服务供给的伦理思考:冲突与对策[J].医学与哲学，2023,44(19):17-19., articleTitle=医保DIP改革与医疗服务供给的伦理思考:冲突与对策, refAbstract=null), Reference(id=1240413553048474089, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=44, issue=19, pageStart=17, pageEnd=19, url=null, language=null, rfNumber=［11］, rfOrder=20, authorNames=Wu YP, Li HJ, Zhang L, journalName=Medicine & Philosophy, refType=null, unstructuredReference=Wu YP, Li HJ, Zhang L, et al. Ethical reflection on the health insurance Dip reform and healthcare service supply:conflicts and strategies[J]. Medicine & Philosophy, 2023, 44(19): 17-19. (In Chinese), articleTitle=Ethical reflection on the health insurance Dip reform and healthcare service supply:conflicts and strategies, refAbstract=null), Reference(id=1240413553165914606, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=43, issue=6, pageStart=1, pageEnd=5, url=null, language=null, rfNumber=［12］, rfOrder=21, authorNames=王冲, 田佳帅, 王晓冬, journalName=中国医院管理, refType=null, unstructuredReference=王冲，田佳帅，王晓冬，等．黑龙江省DIP试点城市运作模式与现状分析[J].中国医院管理，2023,43(6):1-5., articleTitle=黑龙江省DIP试点城市运作模式与现状分析, refAbstract=null), Reference(id=1240413553279160819, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=43, issue=6, pageStart=1, pageEnd=5, url=null, language=null, rfNumber=［12］, rfOrder=22, authorNames=Wang C, Tian JS, Wang XD, journalName=Chinese Hospital Management, refType=null, unstructuredReference=Wang C, Tian JS, Wang XD, et al. Analysis of the operation and current situation in the National pilot cities of Dip in Heilongjiang province[J]. Chinese Hospital Management, 2023, 43(6): 1-5. (In Chinese), articleTitle=Analysis of the operation and current situation in the National pilot cities of Dip in Heilongjiang province, refAbstract=null), Reference(id=1240413553400795642, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2024, volume=43, issue=4, pageStart=64, pageEnd=67, url=null, language=null, rfNumber=［13］, rfOrder=23, authorNames=鲁志鸿, 孙经杰, 李友卫, journalName=中国卫生经济, refType=null, unstructuredReference=鲁志鸿，孙经杰，李友卫，等．DIP支付方式改革对山东省县级中医医院住院服务的影响研究：基于DID的实证研究[J].中国卫生经济，2024,43(4):64-67., articleTitle=DIP支付方式改革对山东省县级中医医院住院服务的影响研究：基于DID的实证研究, refAbstract=null), Reference(id=1240413553576956414, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2024, volume=43, issue=4, pageStart=64, pageEnd=67, url=null, language=null, rfNumber=［13］, rfOrder=24, authorNames=Lu ZH, Sun JJ, Li YW, journalName=Chinese Health Economics, refType=null, unstructuredReference=Lu ZH, Sun JJ, Li YW, et al. Evaluation of the impact of Dip insurance payment reform on inpatient services in county-level traditional Chinese medicine hospitals in Shandong province: a DID based empirical analysis[J]. Chinese Health Economics, 2024, 43(4): 64-67. (In Chinese), articleTitle=Evaluation of the impact of Dip insurance payment reform on inpatient services in county-level traditional Chinese medicine hospitals in Shandong province: a DID based empirical analysis, refAbstract=null), Reference(id=1240413553677619714, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2024, volume=44, issue=8, pageStart=29, pageEnd=32, url=null, language=null, rfNumber=［14］, rfOrder=25, authorNames=李寅飞, 杨永光, 杨阳, journalName=中国医院管理, refType=null, unstructuredReference=李寅飞，杨永光，杨阳，等．DIP医保支付方式改革下医院多维联动精益运营管理研究[J].中国医院管理，2024,44(8):29-32., articleTitle=DIP医保支付方式改革下医院多维联动精益运营管理研究, refAbstract=null), Reference(id=1240413553765700100, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2024, volume=44, issue=8, pageStart=29, pageEnd=32, url=null, language=null, rfNumber=［14］, rfOrder=26, authorNames=Li YF, Yang YG, Yang Y, journalName=Chinese Hospital Management, refType=null, unstructuredReference=Li YF, Yang YG, Yang Y, et al. Research on multi-dimensional linkage lean operation management of hospital under Dip payment[J]. Chinese Hospital Management, 2024, 44(8): 29-32. (In Chinese), articleTitle=Research on multi-dimensional linkage lean operation management of hospital under Dip payment, refAbstract=null), Reference(id=1240413553845391879, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2022, volume=39, issue=9, pageStart=43, pageEnd=48, url=null, language=null, rfNumber=［15］, rfOrder=27, authorNames=李乐乐, 李怡璇, journalName=卫生经济研究, refType=null, unstructuredReference=李乐乐，李怡璇．我国医保支付方式改革的治理路径分析——基于DRG与DIP的机制比较[J].卫生经济研究，2022,39(9):43-48., articleTitle=我国医保支付方式改革的治理路径分析——基于DRG与DIP的机制比较, refAbstract=null), Reference(id=1240413553920889354, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2022, volume=39, issue=9, pageStart=43, pageEnd=48, url=null, language=null, rfNumber=［15］, rfOrder=28, authorNames=Li LL, Li YX, journalName=Health Economics Research, refType=null, unstructuredReference=Li LL, Li YX. Analysis on the governance path of medical insurance payment mode reform in China: comparison of mechanism based on DRG and Dip[J]. Health Economics Research, 2022, 39(9): 43-48. (In Chinese), articleTitle=Analysis on the governance path of medical insurance payment mode reform in China: comparison of mechanism based on DRG and Dip, refAbstract=null), Reference(id=1240413554017358351, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=40, issue=8, pageStart=28, pageEnd=32, url=null, language=null, rfNumber=［16］, rfOrder=29, authorNames=陈非非, 张璐莹, 俞纯璐, journalName=卫生经济研究, refType=null, unstructuredReference=陈非非，张璐莹，俞纯璐，等．DRG付费下创新医疗技术的额外支付机制研究——基于国际经验与启示[J].卫生经济研究，2023,40(8):28-32., articleTitle=DRG付费下创新医疗技术的额外支付机制研究——基于国际经验与启示, refAbstract=null), Reference(id=1240413554101244434, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=40, issue=8, pageStart=28, pageEnd=32, url=null, language=null, rfNumber=［16］, rfOrder=30, authorNames=Chen FF, Zhang LY, Yu CL, journalName=Health Economics Research, refType=null, unstructuredReference=Chen FF,Zhang LY, Yu CL, et al. Study on additional payment mechanism for innovative medical technologies under DRG payment: based on international experience and Enlightenment[J]. Health Economics Research, 2023, 40(8): 28-32. (In Chinese), articleTitle=Study on additional payment mechanism for innovative medical technologies under DRG payment: based on international experience and Enlightenment, refAbstract=null), Reference(id=1240413554185130517, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=43, issue=9, pageStart=94, pageEnd=96, url=null, language=null, rfNumber=［17］, rfOrder=31, authorNames=尚春晓, 陈文, 张璐莹, journalName=中国医院管理, refType=null, unstructuredReference=尚春晓，陈文，张璐莹．德国DRG付费下创新技术支付的经验与启示[J].中国医院管理，2023,43(9):94-96., articleTitle=德国DRG付费下创新技术支付的经验与启示, refAbstract=null), Reference(id=1240413554269016600, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2023, volume=43, issue=9, pageStart=94, pageEnd=96, url=null, language=null, rfNumber=［17］, rfOrder=32, authorNames=Shang CX, Chen W, Zhang LY, journalName=Chinese Hospital Management, refType=null, unstructuredReference=Shang CX, Chen W, Zhang LY. Experience andenlightenment of innovative technology payment under German DRG payment[J]. Chinese Hospital Management, 2023, 43(9): 94-96. (In Chinese), articleTitle=Experience andenlightenment of innovative technology payment under German DRG payment, refAbstract=null), Reference(id=1240413554386457115, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2020, volume=40, issue=3, pageStart=303, pageEnd=305, url=null, language=null, rfNumber=［18］, rfOrder=33, authorNames=沈洪兵, journalName=南京医科大学学报:自然科学版, refType=null, unstructuredReference=沈洪兵．大数据时代的临床医学研究——机遇和挑战[J].南京医科大学学报:自然科学版，2020,40(3):303-305., articleTitle=大数据时代的临床医学研究——机遇和挑战, refAbstract=null), Reference(id=1240413554461954591, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, doi=null, pmid=null, pmcid=null, year=2020, volume=40, issue=3, pageStart=303, pageEnd=305, url=null, language=null, rfNumber=［18］, rfOrder=34, authorNames=Shen HB, journalName=Journal of Nanjing Medicial University, refType=null, unstructuredReference=Shen HB. Clinical medical research in the age of big data-opportunities and challenges[J]. Journal of Nanjing Medicial University, 2020, 40(3): 303-305. (In Chinese), articleTitle=Clinical medical research in the age of big data-opportunities and challenges, refAbstract=null)], funds=[Fund(id=1240413549072273779, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, awardId=72074163, language=CN, fundingSource=国家自然科学基金（面上）项目(72074163), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240413541589635126, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, xref=1., ext=[AuthorCompanyExt(id=1240413541598023734, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, companyId=1240413541589635126, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China), AuthorCompanyExt(id=1240413541606412343, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, companyId=1240413541589635126, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西公共卫生学院／华西第四医院，四川 成都 610041)]), AuthorCompany(id=1240413541711269955, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, xref=2., ext=[AuthorCompanyExt(id=1240413541715464261, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, companyId=1240413541711269955, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学健康城市发展研究中心/西部农村卫生发展研究中心)])], figs=[ArticleFig(id=1240413545293205726, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=EN, label=Fig.1, caption=Kernel density plot of DID values for average medical costs per visit, figureFileSmall=BAX73aZDhk1uw6Q23ZJkkA==, figureFileBig=bnx1xNn61a15IHkci1DG/w==, tableContent=null), ArticleFig(id=1240413545427423461, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=CN, label=图1, caption=次均医疗费用DID值的核密度图, figureFileSmall=BAX73aZDhk1uw6Q23ZJkkA==, figureFileBig=bnx1xNn61a15IHkci1DG/w==, tableContent=null), ArticleFig(id=1240413545540669677, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=EN, label=Fig.2, caption=Kernel density plot of DID values for average healthcare service costs per visit, figureFileSmall=nWb/dXWD5AsziBRYz5NQpQ==, figureFileBig=S5lTukN0w50SFiJngDONtw==, tableContent=null), ArticleFig(id=1240413545712636155, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=CN, label=图2, caption=次均医疗服务费用DID值的核密度图, figureFileSmall=nWb/dXWD5AsziBRYz5NQpQ==, figureFileBig=S5lTukN0w50SFiJngDONtw==, tableContent=null), ArticleFig(id=1240413545834270981, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=EN, label=Fig.3, caption=Kernel density plot of DID values for absolute mean deviation, figureFileSmall=UZDB0DAFYcdyvthyimxz5A==, figureFileBig=jP6wubFCdpK+n5UOWvWXHA==, tableContent=null), ArticleFig(id=1240413545968488714, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=CN, label=图3, caption=离均差绝对值DID值的核密度图, figureFileSmall=UZDB0DAFYcdyvthyimxz5A==, figureFileBig=jP6wubFCdpK+n5UOWvWXHA==, tableContent=null), ArticleFig(id=1240413546090123543, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=EN, label=Fig.4, caption=Kernel density plot of DID values for average length of hospital stay, figureFileSmall=29sLpDkWvHMYlTDMmdKRiw==, figureFileBig=AybIfAQQL4wTLAB45Dr3aw==, tableContent=null), ArticleFig(id=1240413546194981153, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=CN, label=图4, caption=平均住院日DID值的核密度图, figureFileSmall=29sLpDkWvHMYlTDMmdKRiw==, figureFileBig=AybIfAQQL4wTLAB45Dr3aw==, tableContent=null), ArticleFig(id=1240413546287255845, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=EN, label=Fig.5, caption=Kernel density plot of DID values for average material costs per visit, figureFileSmall=v5MdG9CHc450goI90fq8sg==, figureFileBig=oPN+x2sRC3crZV1/SNUNug==, tableContent=null), ArticleFig(id=1240413546387919148, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=CN, label=图5, caption=次均耗材费用DID值的核密度图, figureFileSmall=v5MdG9CHc450goI90fq8sg==, figureFileBig=oPN+x2sRC3crZV1/SNUNug==, tableContent=null), ArticleFig(id=1240413546547302709, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=EN, label=Table 1, caption=

Changes in High-CMI Patients before and after policy implementation

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指标政策前政策后
高CMI人数（人）24 62922 768
高CMI占比（%）2321
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高CMI患者政策前后变化情况

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指标政策前政策后
高CMI人数（人）24 62922 768
高CMI占比（%）2321
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Descriptive statistics of indicators

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指标组别政策前统计描述政策后统计描述
次均费用（元，）对照组7 320.46±11 367.109 818.25±15 282.35
实验组8 319.18±11 150.968 306.84±11 140.47
次均医疗服务费用（元，）对照组2 590.87±4 662.553 804.37±6 276.33
实验组2 389.91±3 874.702 893.55±3 937.83
次均药品耗材费用（元，）对照组1 375.44±2 433.681 432.96±2 765.16
实验组1 764.00±2 444.251 266.98±1 925.04
次均耗材费用（元，）对照组987.94±3 436.241 616.18±5 124.28
实验组1 389.43±5 252.831 521.65±5 935.11
离均差绝对值（元，）对照组3 220.31±6 999.324 205.11±8 781.13
实验组3 166.63±6 350.803 051.93±5 976.76
平均住院日（天，）对照组8.91±11.0110.47±12.64
实验组9.11±7.688.04±7.07
年龄（岁，）对照组44.20±24.9451.53±20.29
实验组53.48±23.2453.96±23.70
性别［n(%)］对照组男10 343(49)4 409(56)
女10 685(51)3 474(44)
实验组男42 502(49)49 844(50)
女43 577(51)50 133(50)
高CMI患者［n(%)］对照组其他16 856(80)5 838(74)
高CMI4 172(20)2 045(26)
实验组其他65 622(76)79 254(79)
高CMI20 457(24)20 723(21)
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指标描述性统计

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指标组别政策前统计描述政策后统计描述
次均费用（元，）对照组7 320.46±11 367.109 818.25±15 282.35
实验组8 319.18±11 150.968 306.84±11 140.47
次均医疗服务费用（元，）对照组2 590.87±4 662.553 804.37±6 276.33
实验组2 389.91±3 874.702 893.55±3 937.83
次均药品耗材费用（元，）对照组1 375.44±2 433.681 432.96±2 765.16
实验组1 764.00±2 444.251 266.98±1 925.04
次均耗材费用（元，）对照组987.94±3 436.241 616.18±5 124.28
实验组1 389.43±5 252.831 521.65±5 935.11
离均差绝对值（元，）对照组3 220.31±6 999.324 205.11±8 781.13
实验组3 166.63±6 350.803 051.93±5 976.76
平均住院日（天，）对照组8.91±11.0110.47±12.64
实验组9.11±7.688.04±7.07
年龄（岁，）对照组44.20±24.9451.53±20.29
实验组53.48±23.2453.96±23.70
性别［n(%)］对照组男10 343(49)4 409(56)
女10 685(51)3 474(44)
实验组男42 502(49)49 844(50)
女43 577(51)50 133(50)
高CMI患者［n(%)］对照组其他16 856(80)5 838(74)
高CMI4 172(20)2 045(26)
实验组其他65 622(76)79 254(79)
高CMI20 457(24)20 723(21)
), ArticleFig(id=1240413548497654107, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=EN, label=Table 3, caption=

Parallel trend test results（P-Value）

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期数次均医疗费用离均差绝对值次均医疗服务费用次均耗材费用次均药品费用平均住院日
政策前2年0.1990.978<0.0010.001<0.0010.031
政策前1年<0.001<0.0010.1170.319<0.0010.088
政策当年0.7160.1340.016<0.001<0.001<0.001
政策后1年0.0130.005<0.0010.0190.145<0.001
政策后2年0.0030.001<0.0010.3310.037<0.001
政策后3年0.0650.5830.378<0.0010.4830.001
), ArticleFig(id=1240413548644454754, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=CN, label=表3, caption=

平行趋势检验结果（P值）

, figureFileSmall=null, figureFileBig=null, tableContent=
期数次均医疗费用离均差绝对值次均医疗服务费用次均耗材费用次均药品费用平均住院日
政策前2年0.1990.978<0.0010.001<0.0010.031
政策前1年<0.001<0.0010.1170.319<0.0010.088
政策当年0.7160.1340.016<0.001<0.001<0.001
政策后1年0.0130.005<0.0010.0190.145<0.001
政策后2年0.0030.001<0.0010.3310.037<0.001
政策后3年0.0650.5830.378<0.0010.4830.001
), ArticleFig(id=1240413548749312360, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=EN, label=Table 4, caption=

Difference-in-Differences (DID) estimation results

, figureFileSmall=null, figureFileBig=null, tableContent=
指标次均医疗费用
（元）		次均医疗服务费用
（元）		次均耗材费用
（元）		离均差绝对值
（元）		平均住院日
（天）
DID效应-803.570-128.434-290.519-228.644-1.080
P值<0.0010.019<0.0010.016<0.001
高cmi×政策交互项-309.400273.834-549.843-234.572-0.715
P值0.033<0.001<0.0010.016<0.001
R20.5860.4750.3870.2980.284
), ArticleFig(id=1240413548824809836, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395011062297453, language=CN, label=表4, caption=

双重差分DID的效应结果

, figureFileSmall=null, figureFileBig=null, tableContent=
指标次均医疗费用
（元）		次均医疗服务费用
（元）		次均耗材费用
（元）		离均差绝对值
（元）		平均住院日
（天）
DID效应-803.570-128.434-290.519-228.644-1.080
P值<0.0010.019<0.0010.016<0.001
高cmi×政策交互项-309.400273.834-549.843-234.572-0.715
P值0.033<0.001<0.0010.016<0.001
R20.5860.4750.3870.2980.284
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按病种分值付费政策对高/低复杂度病例的异质性影响
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罗毓灵 1, 2 , 潘杰 1, 2
现代预防医学 | 卫生政策与管理 2025,52(14): 2575-2581
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现代预防医学 | 卫生政策与管理 2025, 52(14): 2575-2581
按病种分值付费政策对高/低复杂度病例的异质性影响
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罗毓灵1, 2, 潘杰1, 2
作者信息
  • 1.四川大学华西公共卫生学院／华西第四医院，四川 成都 610041
  • 2.四川大学健康城市发展研究中心/西部农村卫生发展研究中心

    • 罗毓灵（1995—），女，硕士在读，研究方向：统计方法与应用

通讯作者:

潘杰，E-mail：
Heterogeneous impacts of diagnosis - intervention packet policy on high/low complexity cases
Yu-ling LUO1, 2, Jie PAN1, 2
Affiliations
  • West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
出版时间: 2025-07-25 doi: 10.20043/j.cnki.MPM.202503240
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摘要
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目的

探讨病种分值付费（DIP）支付改革对高/低复杂度（CMI）病例在数量分布与费用情况上的异质性影响，揭示医院在控费压力下的分层响应机制并建议。

方法

基于DIP试点前后三年数据（2018—2023年），以医保患者作为实验组，其他患者作为对照组，构建双重差分固定效应模型（DID），并在模型中构建病种固定效应与政策×高CMI交互项，量化政策对高/低复杂度病例的异质性影响。

结果

DIP政策显著降低了实验组患者的次均医疗费用（β3=-803.570，P<0.001）与次均医疗服务费用（β3=-128.434，P=0.019），次均耗材费用（β3=-290.519，P<0.001），离均差绝对值降低228.644元（P=0.016），缩短平均住院日1.080天（P<0.001）。分CMI来看，高CMI病例占比降低，相较低CMI病例，高CMI病例次均费用、次均耗材费用、平均住院日等均有额外的降低效应，分别降低309.400元，549.843元，0.715天；次均医疗服务费用反而增长273.834元。

结论

医院在DIP政策压力下对不同CMI病例的响应机制不完全相同，高CMI病例的费用管控空间更大，医院对高CMI病例通过“以技代材”（提升手术技术收入、压缩检查耗材）实现控费，而对低CMI病例依赖全面成本压制。

病种分值付费（DIP）  /  双重差分  /  高CMI病例  /  异质性研究
Objective

To investigate the heterogeneous effects of Diagnosis-Intervention Packet (DIP) payment reform on the quantity distribution and cost patterns of high/low-complexity cases (measured by Case Mix Index, CMI), and to reveal hospital hierarchical response mechanisms under cost-control pressures, thereby providing policy recommendations.

Methods

Using three-year pre-and post-DIP pilot data (2018-2023), we constructed a difference-in-differences (DID) fixed-effects model with medical insurance patients as the treatment group and non-insured patients as the control group. The model incorporated diagnosis-related group (DRG) fixed effects and a policy×high-CMI interaction term to quantify heterogeneous impacts across complexity levels.

Results

The DIP policy significantly reduced per-case medical costs (β3=-803.570, P<0.001), per-case medical service costs (β3=-128.434, P=0.019), and per-case material costs (β3=-290.519, P<0.001) in the treatment group, alongside a reduction in the absolute deviation from the mean by 228.644 CNY (P=0.016) and a shortened average length of stay by 1.080 days (P<0.001). Stratified by CMI, high-CMI cases exhibited additional reductions in per-case costs (β3=-309.400), material costs (β3=-549.843), and hospitalization days (β3=-0.715) compared to low-CMI cases, yet showed an increase in per-case medical service costs (β3=273.834).

Conclusion

Hospitals adopted distinct response mechanisms under DIP-driven cost constraints. For high-CMI cases, cost control was achieved through technology-for-materials substitution (prioritizing technical service income while reducing material expenditures), whereas low-CMI cases relied on comprehensive cost suppression.These findings highlight the need for complexity-tiered payment adjustments to balance cost containment and care quality.

Diagnosis-intervention packet (DIP)  /  Difference-in-differences (DID)  /  High-CMI cases  /  Heterogeneous effects
罗毓灵, 潘杰. 按病种分值付费政策对高/低复杂度病例的异质性影响. 现代预防医学, 2025 , 52 (14) : 2575 -2581 . DOI: 10.20043/j.cnki.MPM.202503240
Yu-ling LUO, Jie PAN. Heterogeneous impacts of diagnosis - intervention packet policy on high/low complexity cases[J]. Modern Preventive Medicine, 2025 , 52 (14) : 2575 -2581 . DOI: 10.20043/j.cnki.MPM.202503240
正文
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按病种分值付费（Diagnosis-Intervention Packet，DIP）是以病种为费用核算单元的医保支付体系，采用大数据方法将患者按“疾病诊断+治疗方式”的特征进行聚类，形成标准化病种，依据病种标准资源消耗予以精准结算的付费方式。自2003年始，DIP陆续在江苏淮安、江西南昌、广州等多地区进行试点[1]。于2020年10月，确定了全国71个试点城市进行推广试点，这意味着DIP正式开始全国性的实践。
相较于传统的按项目付费，DIP支付通过疾病同质化分组和病种均费基准，激励医疗机构优化临床路径、规范诊疗行为，其控费效果已被广泛验证：大量研究表明，DIP实施后次均费用显著下降[2-3]，药品耗材占比降低[4]，费用结构趋于合理[5]。然而，现有研究多聚焦于整体费用变化，却鲜少揭示医院实现控费与结构优化的具体行为机制，尤其是对高复杂度与低复杂度病例的差异化管控策略缺乏深入探讨。这一盲点导致政策设计易陷入“一刀切”困境——忽视高复杂度病例的技术创新需求与低复杂度病例的成本压缩极限，可能加剧医疗供给扭曲。
本研究使用病例组合指数（CMI）来定义病例复杂度[6-7]，CMI是基于DRGs（诊断相关分组）分类及权重值计算得到的综合管理指标，用于衡量疾病严重复杂程度和医疗服务的整体技术难度[8]。本研究构建双重差分模型，通过病种固定效应来排除病种基线差异对结果的干扰，通过引入政策×高CMI交互项来获得高/低CMI病例间的差异，进而揭示DIP政策下高/低CMI病例的异质性响应机制，阐明医院通过“高CMI技术替代”与“低CMI成本压缩”实现控费的内在逻辑。
1　资料与方法
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1.1　数据来源与研究对象
本研究的研究对象为四川省德阳市某三级甲等医院的2018年至2023年的住院患者，共纳入研究对象214 967名。
数据来源于样本医院出院患者的病案首页数据及医院的DRG医院管理系统反馈的病组数据，以政策正式实施年份（2021年10月）为分界点，将2018—2020年设为政策前观测期（2020年10月国家政策发布，存在时滞性），2021—2023年设为政策后观测期。将医保患者（包括城镇职工基本医疗保险患者和城镇居民基本医疗保险患者）患者作为实验组，全自费、全公费、商业保险等其他支付方式的患者作为对照组。以上数据按医保类型、时间、指标3个维度汇总成为混合截面数据。
1.2　结局变量
医保政策直接作用于医保结算费用，所以本研究使用住院次均医疗费用均费和离散程度作为主要结局变量，考虑不同病种间费用差别较大，所以本研究使用患者费用与其对应病种均值间的离均差作为离散程度的测量指标。其次考虑费用结构问题，纳入了次均药品费用、次均材料费用、次均医疗服务费用等指标。最后选取平均住院日作为运营效率指标。
本研究主要分析DIP政策对高/低CMI病例的异质性影响，所以构建政策×高CMI交互项，该交互项就是不同CMI患者间的差异，其中以CMI>1定义高CMI患者[9]。
结合已有研究与政策理论分析，医疗机构为适应 DIP 医保付费改革，会标准化诊疗、提效控本以实现可持续发展[10-11]。鉴于医院在 DIP 政策下对高、低 CMI 病例响应机制不同，高 CMI 倾向费用转化促技术服务，低 CMI 侧重全面成本管控，研究猜想：DIP 政策实施后，实验组与对照组变化趋势不同。医疗费用、相关费用、病种费用离均差、平均住院日等指标将降低。高 CMI 病例次均医疗服务费用可能会增加，次均费用离均差、药耗费用及平均住院日下降会更明显。
1.3　控制变量
参考现有研究选择出年龄、性别、是否手术、是否有并发症等指标作为控制变量[12-13]。考虑病种是影响费用的重要因素，所以本研究将使用固定效应模型，固定到病种层面进行分析。由于无法获得DIP政策前的DIP病组入组情况，所以将DRG诊断组作为固定参数。并且考虑DRG诊断组包含了疾病诊断组、手术、并发症等信息，所以删除了是否手术、是否有并发症等控制变量。该数据通过医院购买的赛思DRG综合管理系统进行获取。
1.4　统计方法
1.4.1　双重差分模型
双重差分（difference-in-difference，DID）模型常用于面板数据分析，在政策效果评估上有广泛应用，本研究将DIP医保付费方式改革政策试点作为一次准自然实验，用DID法对DIP政策对高/低CMI患者的异质性影响进行实证分析，本研究选择使用传统的DID模型，模型为：
式（1）中：y为因变量，R为实验时间的虚拟变量，DIP政策实施之前的年份取值为0，实施之后设为1；T是分组的虚拟变量，实施政策的医保患者组别取值为1，反之取值0；P×T是虚拟时间变量与虚拟分组变量的交互项，它的系数β3反映了政策实施的影响；P×CMI是虚拟时间变量与高CMI患者的交互项，它的系数β4反映了政策实施对高CMI患者的额外影响，γi为控制变量的系数，Xi是控制变量的集合；αjDRGj为病种固定效应；ε是随机误差项。
1.4.2　平行趋势实验
DID模型研究的前提平行趋势检验，本研究通过事件研究法进行检验，根据政策的发生事件构建事前时候供6个时间的虚拟变量eventq，结合eventq对实验组对照组的因变量差异做的固定效应模型分析，如果事前实验组和对照组的因变量差异无显著意义（P>0.05），则认为模型中实验组和对照组对应的因变量在政策实施前有相同变化趋势变化，平行趋势检验的模型如公式2：
式（2）中θ0为常数项，θq为每期系数，eventq为变化期数虚拟变量，γi为控制变量的系数，Xi是控制变量的集合；P×CMI是虚拟时间变量与高CMI患者的交互项；αjDRGj表示病种的固定效应，μpyearp表示时间的固定效应；ε是随机误差项。
1.4.3　安慰剂检验
安慰剂实验是检验DID计结果的稳健性，确定检验政策前后研究结果是否为政策导致的方法。本研究通过使用Stata软件中的permute命令对交互项随机抽取500次，根据系数是否与基准估计结果的差异是否显著来判断是否为安慰剂效应。
2　结果
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2.1　描述性统计
考虑DIP政策对高/低CMI病例的异质性影响，对政策前后高CMI病例占比变化进行总结，如表1，政策后，高CMI患者的数量有降低。
统计样本医院DIP政策前后实验组和对照组的人均医疗费用、人均药品耗材费用、人均医疗服务费用、离均差绝对值、平均住院日的均值及标准差如表2，从政策前后变化看出，实验组次均医疗费用变化不大，次均医疗服务费用、次均耗材费用均有上升，次均药品费用、离均差绝对值、平均住院日等指标有一定程度的降低，这和我们研究猜想有差异，考虑可能政策前后病种结构变化等多种因素，所以还需进一步测量。
2.2　平行趋势检验
平行趋势检验结果如表3所示，尽管部分因变量在事前期某一时间点呈现显著差异（如政策前1年次均医疗服务费用P<0.001），但这个差异可能和数据波动或短期政策影响有关。为进一步验证结果的稳健性，研究进行了安慰剂检验和动态DID分析，结果均支持政策效应的真实性。整体来看次均医疗费用、次均耗材费用、次均医疗服务收入、离均差绝对值、平均住院日等指标均在事前呈现不显著，事后出现显著的情况，符合平行趋势检验，趋势符合平行趋势假设，可以进入下一步双重差分分析。次均药品费用事前期均显著，可能和近年药品相关政策的叠加影响有关，不进入下一步双重差分分析。
2.3　DID回归结果
根据式（1）进行DID回归分析，回归结果见表4，双重差分模型显示，DIP政策显著降低了实验组患者的次均医疗费用（β3=-803.570，P<0.001）与次均医疗服务费用（β3=-128.434，P=0.019），次均耗材费用（β3=-290.519，P<0.001），同时缩短平均住院日1.080天（P<0.001），表明政策在控费与效率提升方面成效显著。此外，费用离均差绝对值的减少（β3=-228.644 ，P=0.016）进一步印证了诊疗行为的标准化趋势。
在高CMI×政策的交互项中，也就是高CMI和低CMI病例的异质性上，高CMI病例次均费用、次均耗材费用、平均住院日等均有额外的降低效应，分别降低309.400元（P=0.033），549.843元（P<0.001），0.72天（P<0.001）；次均医疗服务费用反而增长273.834元（P<0.001）。可能与高CMI病例的费用基数较高、资源使用效率提升空间更大，医院更加关注等原因有关。但在次均医疗服务费用上反而呈现增长的情况，可能与医院通过提升技术水平，将其他费用转化为技术服务费用有关。
2.4　安慰剂检验
对DID交互项进行的500次抽样，检验结果显示对于双侧检验，所有因变量P值均<0.001，均不显著，图1至图5分别展示了次均医疗费用、次均医疗服务费用、离均差绝对值、平均住院日和次均耗材费用的DID估计系数的核密度图。图中黑色垂直线表示真实DID估计系数，灰色曲线表示随机化500次模拟的DID系数分布。真实的DID系数显著偏离随机化后的系数分布，且位于分布的极端位置，表明政策效应并非由随机波动引起。
3　讨论
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3.1　DIP政策对医疗费用与效率的全局影响
本研究显示，DIP政策实施后，样本医院次均医疗费用显著下降，次均耗材费用与平均住院日同步减少，且费用离散度（离均差绝对值β=-228.644，P=0.016）明显降低，印证了DIP政策在控费与诊疗标准化上的有效性。这一结果与既有研究结论一致[14-15]。反映了样本医院在面对DIP政策时的响应和管理优化，例如通过院内智能数据平台对核心病种进行费用结构拆解，联合多部门制定标准化诊疗方案，严格审批超医保目录的药品与耗材使用，并建立抗生素使用动态监控机制，推动成本核算－绩效考核闭环管理、缩短住院周期等。
在DIP政策推进的过程中，DIP制度通过强调医疗内部成本管控体系的重要性，倒逼机构提高精细化管理水平，由粗放型管理向内涵型管理转变。这样的背景下组间的医疗费用离散程度降低是必然趋势，医疗费用的下降应该是短期政策适应以及诊疗规范中的“挤水分”过程。
3.2　高CMI与低CMI病例的异质性响应：机制与实践逻辑
DIP政策对高CMI与低CMI病例的影响呈现显著差异。随着业务发展高CMI/低CMI病例均有增加，但高CMI 病例的占比却较政策后有下降。且高CMI病例的次均医疗费用与耗材费用降幅更大，而次均医疗服务费用却显著上升。结合医院管理实践，从以下机制解释：高CMI病例往往就对应更高的费用，在管理费用的过程中可压缩空间更大，次均医疗费用与耗材费用降幅更大。但医院为了高质量发展，仍在积极推动新技术新业务（如微创手术、靶向治疗）的应用，这导致医疗服务费用结构性上升，反映了医院通过技术替代平衡控费与发展的逻辑。而低CMI病例消耗资源相对较少，费用控制空间有限，更多的是依赖识别同类病例的费用差异，自主优化路径，实现全面的费用管控，进而各种费用均有降低。
这一发现表明，DIP政策的控费效果可以源于医疗费用的全面压缩，也可以通过技术替代平衡控费实现，并且在高CMI患者中更明显。因此，这提示DIP政策在管理的进程中应该关注技术创新的成本，动态调整支付标准以避免抑制创新。
3.3　政策建议
3.3.1　分层设计支付标准，支持高CMI病例技术创新
针对高CMI病例的技术替代效应，建议建立动态支付调整机制，允许医院申报复杂病例的临时支付标准，平衡技术创新与支付公平性。同时，推动区域医疗中心协作，通过技术帮扶提升县级医院高CMI病例诊疗能力，减少患者流失[16-17]。
3.3.2　强化低CMI病例的路径监管与基层分流
将临床路径执行率与医保支付挂钩，防范过度压缩成本导致的服务质量下降；通过医保报销比例倾斜（如基层医院报销提高5%），引导常见病、慢性病患者下沉社区。
3.3.3　重视大数据赋能与AI工具，促进诊疗精准化发展
向医院开放区域病种费用大数据平台，提供同级别医院的费用中位数、最佳实践路径参考，给予临床更多的信息和数据，大数据结合患者个性化信息，从而使诊断准确化、制定治疗方案个性化、患者管理实时化、诊疗效益最大化。借助deep seek等AI工具进行本地化部署实现智能控费，实时监测费用异常并推送优化建议[18]。
4　局限性和未来展望
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本研究仍然存在以下不足：第一，样本来源较单一，本研究的数据仅为单一样本医院数据，未能结合其他地区医院数据共同分析，结论的可推广性稍弱。第二，本研究的分析年限仅在DIP政策实施的第三年，考虑新政策还有适应期，如能纳入更多的年份进行分析，则能进一步讨论政策效果随时间的变化。第三，考虑数据的可及性，结局指标仅考虑费用和平均住院日，指标范围较小，后续如结合三级公立医院绩效考核指标进行更深入的分析，能使政策效果呈现更加全面。尽管如此，相较于以往文献，本研究在现有条件下最大化科学地展开评估，一方面使用双重差分固定效应模型（固定到DRG病组层面）来对研究进行限制，减少政策前后病种差异变化对研究结果的影响，另一方面，通过分析DIP政策对高/低CMI病例的异质性影响，揭示医院实现控费与结构优化的具体行为机制，尤其是对高复杂度与低复杂度病例的差异化管控策略。
未来研究可纳入更多地区、不同类型医院的数据，验证DIP政策效果的普适性。例如，对比县级医院与三甲医院的政策响应差异，揭示区域与层级异质性。在费用与效率指标的基础上，引入医疗质量指标（如再入院率、并发症发生率、患者满意度），全面评估DIP政策的效果，探讨费用下降是否以牺牲质量为代价，为政策优化提供依据。
基金
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  • 国家自然科学基金（面上）项目(72074163)
文献
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参考文献 引证文献
排序方式：
［1］
王樱．江苏淮安：先行者的尝试和探索[J].中国卫生，2020,(12):53-54.
Wang Y.Huai ’an, Jiangsu: The first mover’s attempt and exploration[J]. Chinese Health, 2020, (12): 53-54. (In Chinese)
［2］
金琦，吴双赢，代婷婷，等．基于结构方程模型的广东省人均卫生费用影响因素研究[J].中国卫生统计，2024,41(1):80-83.
Jin Q, Wu SY, Dai TT, et al.Study on the influencing factors of per capita health expenditure in Guangdong Province based on structural equation model[J]. Chinese Journal of Health Statistics, 2024, 41(1): 80-83. (In Chinese)
［3］
林坤河，上官业声，饶娅琦，等．DIP支付方式下医保供给侧政策协同对费用控制的影响研究[J].中国卫生政策研究，2024,17(5):17-24.
Lin KH, Shang Guan YS, Rao YQ, et al. Research on theimpact of supply side policy coordination of medical insurance on cost control under Dip payment method[J]. Chinese Journal of Health Policy, 2024, 17(5): 17-24. (In Chinese)
［4］
黄小红，李云峰，杨业春．相关医改政策的控费效果评价研究——基于“药品零加成”“耗材零加成”和“按病种分值付费”[J].卫生经济研究，2023,40(2):69-73.
Huang XH, Li YF, Yang YC. Evaluation of cost control effect of relevant medical reform policies: based on canceling drug price addition,canceling medical consumable addition and Diagnosis-Intervention packet[J]. Health Economics Research, 2023, 40(2): 69-73. (In Chinese)
［5］
王春雨，陈维雄．DIP实施前后患者住院费用结构变化的实证研究——以广东省10家公立医院为例[J].中国医疗保险，2023,(12):84-89.
Wang CY, Chen WX. An empirical study on the change of inpatient cost structure before and after the implementation of Dip policy——taking ten public hospitalsin Guangdong province as an example[J]. China Health Insurance, 2023, (12): 84-89. (In Chinese)
［6］
Iezzoni L. Risk adjustment for measuring health care outcomes[M]. 4th ed. Chicago: Health Administration Press, 2012.
［7］
李菊红，周林玉，陈灵峰．CMI在促进医疗服务能力提升的作用研究[J].医院管理论坛，2020,37(6),30-32, 14.
Li JH, Zhou LY, Chen LF. Research on CMI and its role in promoting medical service capabilities[J]. Hospital Operation, 2020, 37(6): 30-32, 14. (In Chinese)
［8］
丁磊，左安俊，蒋光峰，等．病例组合指数的内涵及应用探讨[J].中国卫生质量管理，2022,29(7):58-61.
Ding L, Zuo AJ, Jiang GF, et al. The connotation and application of the case combination index[J]. Chinese Health Quality Management, 2022, 29(7): 58-61. (In Chinese)
［9］
李秋莎，杨春晓，赵兹旋，等．我国按病种分值付费（DIP）政策研究——基于国家、省、市三级的比较分析[J].中国卫生政策研究，2022,15(7):8-15.
Li QS, Yang CX,Zhao ZX, et al. Research on the policy of Diagnosis-Intervention Packet (DIP) in China: A comparative analysis based on the national, provincial and municipal levels[J]. Chinese Journal of Health Policy, 2022, 15(7): 8-15. (In Chinese)
［10］
李淑艳，张红，苏凌璎，等．基于DIP下医院病种管理的现状及新型病种管理策略[J].中国卫生标准管理，2023,14(18):45-49.
Li SY, Zhang H, Su LY, et al. Current situation and new disease management strategies of hospital disease management based on Dip[J]. China Health Standard Management, 2023, 14(18): 45-49. (In Chinese)
［11］
吴月苹，李红娟，张亮，等．医保DIP改革与医疗服务供给的伦理思考:冲突与对策[J].医学与哲学，2023,44(19):17-19.
Wu YP, Li HJ, Zhang L, et al. Ethical reflection on the health insurance Dip reform and healthcare service supply:conflicts and strategies[J]. Medicine & Philosophy, 2023, 44(19): 17-19. (In Chinese)
［12］
王冲，田佳帅，王晓冬，等．黑龙江省DIP试点城市运作模式与现状分析[J].中国医院管理，2023,43(6):1-5.
Wang C, Tian JS, Wang XD, et al. Analysis of the operation and current situation in the National pilot cities of Dip in Heilongjiang province[J]. Chinese Hospital Management, 2023, 43(6): 1-5. (In Chinese)
［13］
鲁志鸿，孙经杰，李友卫，等．DIP支付方式改革对山东省县级中医医院住院服务的影响研究：基于DID的实证研究[J].中国卫生经济，2024,43(4):64-67.
Lu ZH, Sun JJ, Li YW, et al. Evaluation of the impact of Dip insurance payment reform on inpatient services in county-level traditional Chinese medicine hospitals in Shandong province: a DID based empirical analysis[J]. Chinese Health Economics, 2024, 43(4): 64-67. (In Chinese)
［14］
李寅飞，杨永光，杨阳，等．DIP医保支付方式改革下医院多维联动精益运营管理研究[J].中国医院管理，2024,44(8):29-32.
Li YF, Yang YG, Yang Y, et al. Research on multi-dimensional linkage lean operation management of hospital under Dip payment[J]. Chinese Hospital Management, 2024, 44(8): 29-32. (In Chinese)
［15］
李乐乐，李怡璇．我国医保支付方式改革的治理路径分析——基于DRG与DIP的机制比较[J].卫生经济研究，2022,39(9):43-48.
Li LL, Li YX. Analysis on the governance path of medical insurance payment mode reform in China: comparison of mechanism based on DRG and Dip[J]. Health Economics Research, 2022, 39(9): 43-48. (In Chinese)
［16］
陈非非，张璐莹，俞纯璐，等．DRG付费下创新医疗技术的额外支付机制研究——基于国际经验与启示[J].卫生经济研究，2023,40(8):28-32.
Chen FF,Zhang LY, Yu CL, et al. Study on additional payment mechanism for innovative medical technologies under DRG payment: based on international experience and Enlightenment[J]. Health Economics Research, 2023, 40(8): 28-32. (In Chinese)
［17］
尚春晓，陈文，张璐莹．德国DRG付费下创新技术支付的经验与启示[J].中国医院管理，2023,43(9):94-96.
Shang CX, Chen W, Zhang LY. Experience andenlightenment of innovative technology payment under German DRG payment[J]. Chinese Hospital Management, 2023, 43(9): 94-96. (In Chinese)
［18］
沈洪兵．大数据时代的临床医学研究——机遇和挑战[J].南京医科大学学报:自然科学版，2020,40(3):303-305.
Shen HB. Clinical medical research in the age of big data-opportunities and challenges[J]. Journal of Nanjing Medicial University, 2020, 40(3): 303-305. (In Chinese)
2025年第52卷第14期
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doi: 10.20043/j.cnki.MPM.202503240
  • 接收时间：2025-03-13
  • 首发时间：2026-03-16
  • 出版时间：2025-07-25
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  • 收稿日期：2025-03-13
基金
国家自然科学基金（面上）项目(72074163)
作者信息
    1.四川大学华西公共卫生学院／华西第四医院，四川 成都 610041
    2.四川大学健康城市发展研究中心/西部农村卫生发展研究中心

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2种不同金属材料的力学参数
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多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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