基于医疗机构真实世界数据的丙型肝炎医保报销政策实施效果评估  

Evaluation of the Implementation Effect of Hepatitis C Medical Insurance Reimbursement Policy Based on RWD of Medical Institutions

作　　者：赵子淇 刘乙瑶 苟亮文 郭昭廷 冯海欢[3] 胡明[1] 

机构地区：[1]四川大学华西药学院,成都610041 [2]四川大学华西医院大数据中心,成都610044 [3]四川大学华西医院医保办,成都610044

出　　处：《中国医疗保险》2024年第2期119-128,共10页China Health Insurance

基　　金：四川省科技厅重点研发项目“丙型病毒性肝炎治疗方案综合评价及全程化诊疗模型的建立研究”(2021YFS0145)。

摘　　要：目的:基于医疗机构真实世界数据,评估丙型肝炎医保报销政策实施效果,为丙型肝炎防治工作和医保政策提供参考和依据。方法:提取四川省成都市某三甲医院2014年1月至2020年12月的电子病历数据,采用间断时间序列分析等方法,从诊疗情况、医疗费用、药物使用和治疗效果等方面分析丙型肝炎患者诊疗行为和疾病负担的变化情况。结果:在诊疗情况方面,成都市门诊特病报销政策实施后就诊人次和治疗人次均出现瞬时增长,实行口服直接抗病毒药物(direct-acting antiviral agents,DAA)单行支付政策后诊疗情况无显著变化;在医疗费用方面,丙型肝炎患者的门诊疗程总费用、自付费用和药品费用均在单行支付政策实施后明显降低。结论:成都市丙型肝炎医保报销政策能够促进丙型肝炎患者积极就医,推动DAA方案的广泛使用,减轻患者负担,提高丙型肝炎的治疗效率。Objective:To evaluate the implementation effect of hepatitis C medical insurance reimbursement policy in Chengdu,and to provide reference and basis for hepatitis C prevention and treatment and medical insurance policy.Methods:The electronic medical record data of a three tertiary hospital in Chengdu from January 2014 to December 2020 were extracted,and the interrupted time series model was used to analyze the changes of diagnosis and treatment behavior and disease burden of hepatitis C patients from the aspects of diagnosis and treatment,medical expenses,drug use and treatment effect.Results:In terms of diagnosis and treatment,the number of visits and treatments increased instantaneously after the implementation of the outpatient reimbursement policy in Chengdu,and there was no significant change after the implementation of the single line payment policy for oral direct antiviral(DAA) drugs.In terms of medical expenses,the total cost of treatment,out of pocket expenses and drug expenses of hepatitis C patients have been significantly reduced after the implementation of the single line payment policy.Conclusion:Chengdu hepatitis C medical insurance reimbursement policy can promote hepatitis C patients to actively seek medical treatment,promote the widespread use of DAA scheme,reduce the burden of patients,and improve the treatment efficiency of hepatitis C.

关 键 词：丙型肝炎 政策绩效 报销政策 间断时间序列分析 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]