《保险研究》20251108-《DRG支付方式对医疗费用的影响研究——基于PSM-DID模型的实证分析》（苏宏通、周建军、李颖琦、梁思源）

［摘   要］我国医保体系正向高质量发展转型，DRG支付是我国医保支付方式改革的重要内容之一，在优化医保资金使用效率、控制医疗费用不合理增长、提高医疗服务质量和效率方面发挥重要作用。本文利用上海市DRG支付试点某三甲综合医院2019~2023年住院病例数据,采用PSM-DID模型，实证检验DRG支付方式改革的阶段性政策效果。结果表明，DRG支付方式有效抑制了医疗总费用的增长，缓解了医保基金支出压力，但对各类细分费用的影响具有异质性；DRG支付方式对医疗费用的影响存在分层效应，高费用组和低费用组的医疗费用呈现不同的变化趋势；在住院时长方面，DRG支付方式实施后整体住院天数明显缩短，但是复杂病例的住院天数有所增加。DRG支付方式改革在实现医疗费用总量控制的基础上，也引导医院根据病例风险特征采取差异化的资源配置策略。

［关键词］医保支付方式；按疾病诊断相关分组(DRG)；医疗费用

［作者简介］苏宏通，上海国家会计学院讲师、硕士生导师,研究方向:医疗机构运营管理；周建军，上海财经大学商学院博士研究生，上海申康医院发展中心正高级会计师,研究方向：医院财务管理与运营管理；李颖琦（通讯作者），上海国家会计学院教授、博士生导师，上海国家会计学院医院运营管理研究中心主任，研究方向：医院运营管理、审计理论与实践；梁思源，上海对外经贸大学会计学院讲师、硕士生导师，研究方向：医疗机构运营管理。

An Empirical Analysis of the Impact of DRG Payment Method on Medical Expenses—Evidences from PSM-DID Model

SU Hong-tong，ZHOU Jian-jun，LI Ying-qi， LIANG Xi-yuan

Abstract：China’s healthcare insurance system is undergoing a transformation towards high-quality development.Diagnosis-Related Groups (DRG) payment reform serves as a critical component of the national healthcare payment system reform.This reform plays a pivotal role in optimizing the efficiency of medical insurance fund utilization,curbing unreasonable growth in healthcare expenditures,and enhancing the quality and efficiency of medical services.Leveraging inpatient case data from a tertiary general hospital participating in Shanghai’s DRG payment pilot program from 2019 to 2023,this study employs a Propensity Score Matching-Difference in Differences (PSM-DID) model to empirically evaluate the phased policy effects of the DRG payment reform.The findings reveal that the adoption of the DRG payment has effectively curbed the growth of total medical expenses,thereby alleviating the financial pressure on the healthcare insurance fund.Meanwhile,there is heterogeneity regarding its impacts on different cost components.The DRG payment has stratified effects on medical expenses,with costs in high- and low-cost groups moving in different directions.In terms of length of stay,the overall hospitalization duration is shortened noticeably after DRG implementation,yet it is extended for more complicated cases.Beyond achieving the goal of aggregate medical expenses control,the DRG payment reform guides hospitals in adopting differentiated resource allocation strategies based on medical risks.

Key words：methods of payment of healthcare insurance;Diagnosis-Related Groups (DRG);healthcare expenditure