北京市DRG试点医院脑缺血性疾病伴重要合并症与伴随病药品费用的研究  

Research on Drug Expenses of Cerebral Ischemic Diseases with Major Comorbidities and Concomitant Diseases in the DRG Pilot Hospitals in Beijing

作　　者：王文娟[1] 胡洋溢 和宇航 曹馨彤 王朝阳 蔡媛青 WANG Wen-juan;HU Yang-yi;HE Yu-hang(School of Government,Central University of Finance and Economics,Beijing,100081,China)

机构地区：[1]中央财经大学政府管理学院,北京100081 [2]中国社会科学院中国社会科学评价研究院,北京100732

出　　处：《中国卫生经济》2023年第2期6-10,共5页Chinese Health Economics

基　　金：国家社会科学基金青年项目(22CGL052);国家自然科学基金项目(71473284)。

摘　　要：目的:分析北京市首批DRG试点的全部6家医院脑缺血性疾病伴重要合并症与伴随病住院患者药品费用在医药分开和医耗联动综合改革(以下统称两轮综合改革)中的变化情况,为深化两轮综合改革提供依据。方法:应用间断时间序列模型分析2016—2020年6家北京市DRG试点医院的脑缺血性疾病伴重要合并症与伴随病住院患者例均药品费用及药品费用占比变化情况。结果:患者例均药品费用及例均西药费、例均中药费的整体费用水平均大幅降低,并都在改革后继续减少;药品费用占比、西药费占比和中药费占比也大幅降低,其中药品费用占比和西药费占比在改革后继续减少,中药费占比保持稳定。结论:两轮综合改革基本实现预期政策目标,但需关注长期控费的效果与中药、西药均衡发展,建议发挥DRG的引导功能,推进药品带量集中采购与DRG联动改革,建立DRG绩效评价体系,推进DRG付费与临床路径有机结合和探索按中医病种付费。Objective:To analyze the changes of drug expenses of inpatients with cerebral ischemic diseases with major comorbidities and concomitant diseases in 6 hospitals of the first Diagnosis Related Group(DRG) pilot in Beijing during the comprehensive reform of separation of medicines and medical consumption linkage in Beijing,and provide references for deepening these two rounds of reform.Methods:The interrupted time series model was applied to analyze the changes of the average drug expenses and the proportion of drug expenses before and after these two reforms in 6 DRG pilot hospitals from 2016 to 2020.Results:The overall level of average drug expenses,western drug expenses and Chinese drug expenses decreased significantly,and expenses continued to decrease after the reform.The proportion of total drug expenses,western drug expenses and Chinese drug expenses also decreased significantly,among which the proportion of total drug expenses and western drug expenses continued to decrease after the reform,and the proportion of Chinese drug expenses remained stable.Conclusion:These two rounds of reform have basically achieved the expected policy goals.but attention should be paid to the long-term cost control effect and the balanced development of Chinese and western medicine.It suggested to perform the DRG important guiding function,promote the linkage reform of the centralized purchase of drugs with volume with DRG,establish DRG performance evaluation system,promote the organic combination of DRG payment and clinical pathway,and explore payment according to TCM diseases.

关 键 词：医药分开 医耗联动 按疾病诊断相关分组 药品费用 间断时间序列 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R197