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作 者:涂磊昊 林振吕[1] 王珊珊[1] 王晓玲 TU Leihao;LIN Zhenlyu;WANG Shanshan;WANG Xiaoling(Medical Insurance Office,The First Affiliated Hospital of Fujian Medical University,Fuzhou Fujian 350003,China)
机构地区:[1]福建医科大学附属第一医院医保办公室,福建福州350003
出 处:《中国卫生标准管理》2021年第19期40-43,共4页China Health Standard Management
摘 要:目的研究将肿瘤靶向药物纳入医保支付范围的可行性。方法参考笔者所在医院肿瘤科门诊靶向药纳入医保前后各月月份数据,分析间断时间序列,探讨靶向药纳入医保后的影响。结果门诊医保后,门诊量上涨132.45人次,医保前的门诊趋势则为下降,每月下降17.75人次,医保后的趋势每月上涨20人次,较医保前趋势变动增长37.75人次,医保后门诊次均费用降幅139.76元,医保前门诊次均趋势,涨幅58.26元/月,医保后该趋势变为上涨24.74元/月;住院次均费用,医保后随即下降了923.15元。医保后门诊和住院均有所上涨,医保前的基线趋势每月分别下降1.31%、1.61%,医保后则出现了涨幅。门诊和住院的辅助用药占比分别出现长期降幅;医保后门诊类实际补偿比出现1.12%的降幅。结论靶向药物纳入医保后为患者带来了福利,不影响医院就诊人数。Objective To study the feasibility of including tumor-targeted drugs into the scope of medical insurance payment.Methods Referred to the monthly data before and after the targeted drugs were included in the medical insurance in a cancer hospital,analyzed the intermittent time series,and explored the impact of the targeted drugs in the medical insurance.Results After the outpatient medical insurance,the number of outpatient visits increased by 132.45,the outpatient trend before the medical insurance decreased,with a monthly decrease of 17.75 visits,and the trend after the medical insurance increased by 20 visits per month,an increase of 37.75 visits compared with the trend change before the medical insurance,and after medical insurance,the average cost of outpatient visits dropped by 139.76 yuan.The average number of outpatient visits before medical insurance increased by 58.26 yuan/month.After medical insurance,the trend became an increase of 24.74 yuan/month;the average hospitalization cost dropped by 923.15 yuan after medical insurance.Both outpatients and hospitalizations rose after medical insurance.The baseline trend before medical insurance decreased by 1.31%and 1.61%each month,and there was an increase after medical insurance.The proportion of adjuvant drugs has long-term declines in outpatient and hospitalization respectively;the actual outpatient compensation ratio after medical insurance has dropped by 1.12%.Conclusion The inclusion of targeted drugs in medical insurance brings benefits to patients and does not affect the number of hospital visits.
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