财经问题研究

提升医疗服务价值是医保DRG付费改革的核心目标。本文基于H市医保DRG付费改革前后长达6年的医保结算月度数据，采用中断时间序列分析方法，从医疗服务成本、医疗服务效率和医疗服务质量三个维度，研究了医保DRG付费改革对医疗服务价值的促进作用。研究发现，医保DRG付费改革通过“结余留用”的激励机制倒逼医疗机构控费增效，降低了医疗服务成本，提升了医疗服务效率，也优化了费用结构，特别是通过费用结构的“腾笼换鸟”实现了医务性收入占比的上升。但是，随着改革的深入推进，出现了医疗服务质量下降等问题。对此，本文认为应从“支付—监管—评价”三位一体的政策优化视角完善DRG付费体系。

Excessive medical treatment is a persistent problem in China's healthcare system, leading to unreasonable increases in medical expenses, burdening patients, wasting resources, and affecting the sustainability of medical insurance funds. Fee-for-service(FFS) payment fails to effectively curb excessive medical treatment, necessitating a reform of medical insurance payment methods. As a crucial practice in China's medical insurance payment reform, empirical research on whether DRG payment enhances the value of medical services is necessary to provide evidence-based support for policy improvement.Value-based healthcare emphasizes reducing costs while ensuring the quality of diagnosis and treatment, improving patient outcomes and health performance, and pursuing “the highest cost-effectiveness of medical care”. Therefore, medical costs, service efficiency, and service quality are critical dimensions for evaluating value-based healthcare. Based on 72 months of monthly medical insurance settlement data from 50 medical institutions in H City before and after the DRG payment reform, this paper employs an interrupted time series regression method of quasi-experimental research to comprehensively assess the impact of DRG on medical value in three dimensions: medical service cost, medical service efficiency, and medical service quality. This paper finds that the DRG payment reform has achieved phased results, driving medical institutions to control costs and increase efficiency through the “keep the surplus” incentive mechanism, reducing medical service costs, improving medical service efficiency, optimizing cost structure, and particularly enhancing the proportion of medical income through the “reallocation of funds”. However, it is essential to note and be vigilant about issues such as weakened cost control effects, hospitalization segmentation, and decreased medical service quality as the DRG reform deepens. Additionally, the DRG payment reform has heterogeneous effects on different levels of medical institutions, particularly in the optimization path of cost structure.The marginal contributions of this paper lie in the following aspects. Firstly, it comprehensively examines the impact of DRG payment reform from the perspective of value-based healthcare and its multidimensional implications of service cost, service efficiency, and service quality. Secondly, it depicts the policy effects and their changes over a long six-year period before and after the reform, contributing to the discovery of time effects. Thirdly, it analyzes the heterogeneity of the DRG payment reform's impact on different levels of medical institutions, especially primary-level medical institutions,which are relatively neglected in existing research. The findings of this study provide a solid foundation for further optimizing DRG payment policies.