终末期肾病患者治疗费用负担分析与政策建议  

Analysis on treatment burden of end-stage renal disease patients and related policy suggestions

作　　者：王文仪[1] 梁鸿[1] 芦炜[2] WANG Wenyi;LIANG Hong;LU Wei(School of Social Development and Public Policy,Fudan University,Shanghai 200433,China;School of Economy and Management,Hainan Normal University,Haikou 571158,Hainan China)

机构地区：[1]复旦大学社会发展与公共政策学院,上海200433 [2]海南师范大学经济与管理学院,海口571158

出　　处：《中国卫生资源》2018年第2期121-126,共6页Chinese Health Resources

摘　　要：目的分析终末期肾病患者的维持性肾脏替代治疗(包括肾透析和肾移植抗排异)费用支出与构成,测算经济成本,为终末期肾病卫生资源配置与保障政策制定提供依据。方法对上海市医疗保险参保人中肾透析、肾移植的大病标识人员时间序费用数据进行描述性分析和t检验。结果 2007—2013年血液透析、腹膜透析、肾移植患者年均费用分别为10.75万元、8.60万元和11.22万元,涨幅分别为5.18%、3.27%和1.27%。在连续治疗8年后,血液透析、腹膜透析、肾移植患者累计支出治疗费用102.70万元、87.16万元、87.24万元,血液透析治疗支出最高。在三级医院治疗的血液透析患者年均治疗支出高于在二级医院治疗的患者,腹膜透析则相反。结论应基于经济适宜性优先推广腹膜透析,手段包括建立腹膜透析三级诊疗服务体系,优化透析治疗的保障政策,通过病种管理实现倾斜激励。Objective To analyze the expenditure and composition of the maintenance renal replacement therapy(including dialysis and kidney transplant anti-rejection therapy)in patients with end-stage renal disease,and to estimate the economic cost so as to provide the basis for policy formulation and guarantee of health resources for end-stage renal disease.Methods Descriptive statistical analysis and T-test were used to analyze the time-series expenditure data of serious illnesses in dialysis patients and kidney transplant recipients in Shanghai insured patients.Results Firstly,the average annual expenditure of hemodialysis,peritoneal dialysis and kidney transplantation from 2007 to 2013 were 107 500 yuan,86 000 yuan and 112 200 yuan,respectively,increasing 5.18%,3.27%and 1.27%,respectively.Secondly,after eight years of continuous treatment,total treatment expenditure of hemodialysis,peritoneal dialysis and kidney transplant patients was 1.027 million yuan,871 600 yuan and 872 400 yuan.The treatment expenditure of hemodialysis was the highest.Thirdly,the hemodialysis patients who received treatment in tertiary hospital cost more than those in secondary hospital,while the expenditure of peritoneal dialysis had the opposite situation,and the kidney transplant was only allowed in tertiary hospitals.Conclusion It is recommended that peritoneal dialysis be promoted as a priority choice on the basis of economic suitability through the establishment of a hierarchical diagnosis and treatment health service network,optimization of the health insurance policy and provision of purposive incentive via DRGs.

关 键 词：终末期肾病 腹膜透析 医疗费用 成本比较 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R5