某市医保人群的恶性肿瘤疾病负担研究  

Study on Medical Service Utilization and Burden of Malignant Tumor Based on Medical In surance Population in a certain City

作　　者：崔亚萍[1] 周守君[2,4] 黄汉民 Cuiya Ping;Zhou Shoujun;Huang Hanming(Department of Medical Record,Jiangsu Provincial Cancer Hospital,Nanjing 210009;Department of Medical Insurance,,Jiangsu Provincial Cancer Hospital,Nanjing 210009,China;Department of Medical Insurance,Nanjing Social Security Center,Nanjing Jiangsu 210017;School of Medical Policy&Management,Nanjing Medical University,Nanjing Jiangsu 210029,China)

机构地区：[1]江苏省肿瘤医院病案室,江苏南京210009 [2]江苏省肿瘤医院医保办,江苏南京210009 [3]南京市社会保障中心医保部,江苏南京210017 [4]南京医科大学医政学院,江苏南京210029

出　　处：《江苏卫生事业管理》2020年第3期323-327,共5页Jiangsu Health System Management

基　　金：江苏省预防医学科研课题(Y2013055);江苏省医院协会医院管理创新研究课题(JSYGY-3-2018-262);江苏省医学科研课题(X2017-007)。

摘　　要：目的:调查分析医保人群恶性肿瘤流行病学负担、医疗服务需求、医药费用等情况。方法:抽取2010—2014年某市城镇职工基本医疗保险人群的总体信息和全部新发肿瘤病例信息,使用SPSS21.0软件进行分析潜在寿命损失年(YPLL)、潜在经济损失,评价恶性肿瘤疾病负担。结果:41145例患者医药费用总计57.39亿,其中生存患者31.68亿元,死亡患者25.70亿元。生存患者、死亡患者发病后12个月内的医药费用占各自全部医药费用的比例为50.7%、53.71%。死亡患者平均寿命损失15.2年/例,潜在经济损失平均42.1万元/例,死亡前12个月内医药费用占自身全部医药费用的69.8%。平均潜在经济损失最高的前3个病种为:卵巢癌、白血病和子宫颈癌。结论:医保人群恶性肿瘤患者疾病负担主要来自于寿命损失和医药费用,医药费用集中发生在发病后12个月和死亡前12个月。女性肿瘤疾病负担尤为突出。Objective:To investigate and analyze the epidemiological burden,medical service demand and medical expenses of malignant tumors in medical insurance population.Methods:Extract the general information and all new tumor case information in 2010-2014 of the medical insurance population in a city,use SPSS 21.0 software to calculate potential life loss year(YPLL),potential economic losses,used to evaluate the burden of malignant tumors.Results:Among the 41,145 patients,medical expenses totaled 5.739 billion,of which were composed of 3.168 billion yuan form survival patients and 2.570 billion yuan form dead patients.The medi cal expenses of the survival patients and the death patients with in 12 months after the onset of illness accounted for 50.7%and 53.71%of the total medical expenses respectively.The average loss of life of death cases was 15.2 years/case,and the average potential economic loss was 421,000 yuan/case.The medical expenses of last 12 months of death cases accounted for 69.8%of all medical expenses.The top three diseases with the highest potential economic losses were ovarian cancer,leukemia and cervical cervix cancer.Conclusion:The disease burden of patients with malignant tumors in the medical insurance population was heavy,which mainly comes from life loss,potential economic loss and medical expenses.The medical expenses are concentrated in 12 months after the onset and last 12 months of death case.The burden of women tumor is particularly prominent.

关 键 词：疾病负担 医保人群 肿瘤 潜在寿命损失年 潜在经济损失 医疗服务利用 

分 类 号：R197.1[医药卫生—卫生事业管理]