Analysis of medical reimbursement rate and influencing factors under the DIP payment method
10.3969/j.issn.1674-2982.2024.06.006
- VernacularTitle:DIP支付方式下医疗机构医保支付率及影响因素分析
- Author:
Meng-Yuan ZHAO
1
;
Kun-He LIN
;
Ying-Bei XIONG
;
Yi-Fan YAO
;
Zhi-He CHEN
;
Yu-Meng ZHANG
;
Li XIANG
Author Information
1. 华中科技大学同济医学院医药卫生管理学院 湖北武汉 430030
- Keywords:
Medical reimbursement rate;
Medical insurance;
DIP;
Heterogeneity analysis
- From:
Chinese Journal of Health Policy
2024;17(6):40-46
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Analyze the medical reimbursement rate and influencing factors under the DIP payment method to refine the DIP payment policy,promote the optimization of internal operations in medical institutions,and ensure reasonable compensation.Methods:Based on the 2022 DIP fund settlement data from 196 medical institutions in City A,the study used multiple linear regression to analyze the factors affecting medical reimbursement rate and conducted a heterogeneity analysis for medical institutions of different levels.Results:The medical reimbursement rate for medical institutions in City A in 2022 was 103.32%.Medical institutions with lower CMI standardized inpatient costs,lower rates of deviation cases,tertiary care institutions,lower proportion of level-four surgeries,and lower ratios of resident to employee medical insurance cases have higher medical reimbursement rate(P<0.05).Heterogeneity analysis reveals that therates of deviation cases,the proportion of primary care diseases,the ratio of resident to employee medical insurance cases,and the low-standard admission rate have different impacts on medical institutions of different levels.Conclusion:Medical insurance departments should improve policies for primary care diseases,dynamically adjust disease catalogs and payment standards,optimize funding levels and institutional coefficients,and increase penalties for violations to ensure effective use of funds.Medical institutions need to strengthen their understanding of policies,focus on refined internal management,promote standardized and rational diagnosis and treatment through performance assessment transformation,and leverage their own advantages in medical services to reasonably increase the medical reimbursement rate.
