医保费用定额结算干预对临床合理用药的影响  

Effect of quota settlement intervention for medical insurance costs on clinical rational drug use

作　　者：安小芳[1] 安焕萍 周晓玲 吕军[4] AN Xiaofang;AN Huanping;ZHOU Xiaoling(Department of Medical Insurance,the First Affiliated Hospital of Xi'an Jiao Tong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院医保办,陕西710061 [2]西安交通大学第一附属医院急诊科,陕西710061 [3]西安交通大学第一附属医院骨科,陕西710061 [4]西安交通大学第一附属医院临床研究中心,陕西710061

出　　处：《安徽医学》2018年第2期229-232,共4页Anhui Medical Journal

基　　金：国家社会科学基金一般项目(项目编号:16BGL183)

摘　　要：目的分析医保费用定额结算干预对临床合理用药的影响。方法选取2015年7~12月患者住院费用未实施定额结算管理模式的子宫平滑肌瘤、腹股沟疝及胆囊炎病例各200例(非定额组);选取2016年1~6月患者住院费用实施定额结算管理模式的子宫平滑肌瘤、腹股沟疝及胆囊炎病例各200例(定额组)。比较分析两组患者住院费用、药品费用、药占比、基本药物和抗菌药物使用情况。结果子宫平滑肌瘤、腹股沟疝定额组住院费用、药品费用、药占比均低于非定额组,差异有统计学意义(P<0.05);胆囊炎组药品费用、药占比定额组[(4 001.25±929.83)元、0.34±0.06]低于非定额组[(6 121.23±993.01)元、0.51±0.14],差异有统计学意义(P<0.05);子宫平滑肌瘤、胆囊炎平均住院日定额组[(8.96±1.03)天、(6.46±1.48)天]短于非定额组[(10.04±1.01)天、(8.25±1.75)天],差异有统计学意义(P<0.05);子宫肌瘤、胆囊炎组基本药物合理使用率定额组(98.00%、94.00%)高于非定额组(91.50%、85.50%),差异有统计学意义(P<0.05);腹股沟疝、子宫平滑肌瘤和胆囊炎抗菌药物合理使用率定额组(99.50%、93.50%、92.00%)高于非定额组(89.00%、81.00%、80.00%),差异有统计学意义(P<0.05);基本药物不合理使用类别中未首选国家基本药物占30.56%排在首位,抗菌药物不合理使用类别中无指征用药占38.46%排在首位。结论医保费用定额结算方式在确保患者用药安全的同时,能有效降低患者的医疗及药品费用。Objective To analyze the effect of quota settlement intervention formedical insurance costs on clinical rational drug use.Methods Patients with uterine leiomyoma,inguinal herniaorcholecystitis,200 cases in each disease entity,hospitalized from Jul 2015 to Dec 2015 and had their expenses settled via management mode of non-quota settlement were collected asthe non-quota group.Meanwhile,other 600 cases of patients with matching disease and numberhospitalized from Jan 2016 to Jun 2016 and hadtheir expenses settled via mode of quota settlement were collected as the quota group.Theirhospitalization expenses,drug expenditure and drug proportion,together with usage ofessential drugs and antibacterial drugs between the quota and non-quota groups were compared andanalyzed.Results The hospitalization expenses,drug expenditure and drug proportion in patients with uterine leiomyoma or inguinal hernia in the quota group were significantly lower than those inpatients withuterine leiomyoma or inguinal herniain the non-quotagroup(P<0.05).The drug expenditure and drug proportion ofcholecystitis in the quota group were lower than those in the non-quotagroup,with significant differences between them(P<0.05).The average hospitalization days of uterine leiomyoma or cholecystitis patients in the quota group(8.96±1.03d,6.46±1.48 d)were significantlyshorter than thoseof uterine leiomyoma or cholecystitispatients in the non-quota group(10.04±1.01 d,8.25±1.75 d;P<0.05).The rational usage rate of essential drugs of uterine leiomyoma or cholecystitispatients in the quota group(98.00%,94.00%)was significantly higher than that in the non-quotagroup(91.50%,85.50%;P<0.05).The rational usage rate of antibacterial drugs of patients with inguinal hernia,uterine leiomyoma orcholecystitis in the quota group(99.50,93.50%,92.00%)were also significantly higher than that in the non-quotagroup(89.00%,81.00%,80.00%),and their differences were all statistically significant(P<0.05).The cause of without correct preference of the national essential drugs a

关 键 词：医疗保险 定额结算 合理用药 

分 类 号：R197.32[医药卫生—卫生事业管理]