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[1]邢倩胡宏飞何达陈天池王海银.脑深部电刺激疗法的医保支付比例调整对患者医疗费用影响研究[J].中国卫生质量管理,2025,32(10):70-73.[doi:10.13912/j.cnki.chqm.2025.32.10.14]
　XING Qian,HU Hongfei,HE Da.Research on the Impact of Adjustments in Medical Insurance Payment Proportions for Deep Brain Stimulation Therapy on Patients’ Medical Expenses[J].Chinese Health Quality Management,2025,32(10):70-73.[doi:10.13912/j.cnki.chqm.2025.32.10.14]

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脑深部电刺激疗法的医保支付比例调整对患者医疗费用影响研究

《中国卫生质量管理》[ISSN:1006-7515/CN:CN 61-1283/R] 卷: 32 期数: 2025年10期页码: 70-73 栏目: 卫生技术评估专栏出版日期: 2025-10-15

Title:: Research on the Impact of Adjustments in Medical Insurance Payment Proportions for Deep Brain Stimulation Therapy on Patients’ Medical Expenses

作者:: 邢倩胡宏飞何达陈天池王海银; 上海市卫生和健康发展研究中心/上海市医学科学技术情报研究所

Author(s):: XING Qian; HU Hongfei; HE Da; Shanghai Health Development and Research Centre/Shanghai Medical Science and Technology Information Institute

关键词:: 医保支付; 脑深部电刺激疗法; 高值疗法; 住院费用; 断点回归

Keywords:: Medical Insurance Payment; Deep Brain Stimulation; High-Value Therapy; Hospitalization Expenses; Regression Discontinuity Design

分类号:: R197.323

DOI:: 10.13912/j.cnki.chqm.2025.32.10.14

文献标志码:: A

摘要:: 目的以脑深部电刺激疗法为例，分析医保支付比例调整对患者医疗费用的影响，为高值耗材治理及医保支付政策优化提供科学依据。方法以2017-2023年上海市脑深部电极植入术医保结算患者为样本，采用断点回归模型，实证分析上海市两次医保支付比例调整前后患者医疗费用负担差异。结果两次医保支付比例调整前后，患者支付费用均有不同程度下降，医保支付费用增加，第二次调整报销比例住院总费用增加（P＜0.05），不同带宽检验下结果具有稳健性。结论医保支付比例调整对患者具有降费减负效应，产业更新迭代等因素导致总费用增加。需要进一步提升手术管理能力，深入探索医保基金智能监测措施，优化疾病分组与支付标准，保障基金可持续性。

Abstract:: ObjectiveTaking deep brain stimulation therapy as an example, this study analyzes the impact of adjustments in medical insurance payment proportions on patients’ medical expenses, providing a scientific basis for the governance of high-value consumables and the optimization of medical insurance payment policies.MethodsUsing patients who underwent deep brain electrode implantation and settled medical insurance claims in Shanghai from 2017 to 2023 as samples, a regression discontinuity design model was employed to empirically analyze differences in patients’ medical expense burdens before and after two adjustments in Shanghai’s medical insurance payment proportions.ResultsFollowing both adjustments in payment proportions, patients’ out-of-pocket expenses decreased to varying degrees, while medical insurance fund expenditures increased. After the second adjustment, total hospital cost with reimbursement proportions rose (P < 0.05), and the results remained robust under different bandwidth tests.Conclusion Adjustments in medical insurance payment proportions have a cost-reducing and burden-alleviating effect on patients, although factors such as industrial upgrades and iterations contribute to increases in total expenses. It is necessary to further enhance surgical management capabilities, continuously explore intelligent monitoring measures for medical insurance funds, optimize disease grouping and payment standards, and ensure the sustainability of the funds.

参考文献/References:

［1］上海市医疗保障局. 关于印发《上海市进一步完善多元支付机制支持创新药械发展的若干措施》的通知：沪医保发〔2023〕 2号［EB/OL］.(2023-07-28)［2025-03-30］. https://ybj.sh.gov.cn/zxzc/20230 731/6f30a84882fa4fac982feabd3 1121a56.html.［2］ZHOU RA, BAICKER K, TAUBMAN S, et al. The uninsured do not use the emergency department more—they use other care less［J］. Health Aff,2017,36(12):2115-2122.［3］程龙，牟青春. 深部脑电刺激在脑卒中后遗症治疗中的研究进展［J］. 海南医学,2024,35(8):1200-1203.［4］VENKATARAMANI AS, BOR J, JENA AB. Regression discontinuity designs in healthcare research［J］. BMJ,2016,352：1216.［5］陈杨，潘杰. 基于双断点回归分析的取消耗材加成与带量采购政策对患者住院费用的影响研究［J］. 现代预防医学,2023,50(16):3000-3005.［6］CALONICO S, CATTANEO MD, FARRELL MH, et al. Regression discontinuity designs using covariates［J］. REStat,2019,101(3):442-451.［7］FANN JCY, CHANG KC, YEN AMF, et al. Cost-effectiveness analysis of deep brain stimulation for parkinson disease in Taiwan［J］. World Neurosurg,2020,138:e459-e468.［8］郭晋晖. 医保异地就医总费用11年增7倍四成患者流入上海北京广东［N］. 第一财经日报,2024-04-11(A10).［9］魏巍，孙明，徐茂云. DRG支付下IF55病种医用耗材应用现状与对策研究［J］. 中国卫生质量管理,2023,30(12):28-32.［10］郑莹，王泽洲，吴炅. 基于单病种数据库的临床科研平台构建探索［J］. 中国卫生质量管理,2023,30(7):30-32.

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更新日期/Last Update: 2025-10-15