公立医院医用耗材成本管控与结构优化实践——经导管肝动脉栓塞术中载药栓塞微球的使用管控案例分析  

Cost control and structural optimization of medical consumables in a public hospital:a case study on the management of drug-loaded embolic microspheres in transcatheter Hepatic Artery Embolization

作　　者：谭嘉文 杨治论 缪家清 吕晓慧 吴丽华[1] 余冬兰[1] TAN Jiawen;YANG Zhilun;MIAO Jiaqing;LV Xiaohui;WU Lihua;YU Donglan(The First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Shenzhen People’s Hospital,Shenzhen 518020,China)

机构地区：[1]中山大学附属第一医院,广东广州510080 [2]深圳市人民医院,广东深圳518020

出　　处：《现代医院》2024年第11期1694-1698,1701,共6页Modern Hospitals

基　　金：国家卫生健康委医院管理研究所2022医学工程研究项目(2022MEB209)。

摘　　要：公立医院医用耗材的成本管控与结构优化有利于其从粗放式的控费管理转变为科学化、精细化管理。在保证医疗质量的前提下,降低患者诊疗负担,符合公立医院高质量发展需求,是实现价值医疗的必经之路。某三级甲等医院综合医用耗材医疗价值和经济价值双重管理属性,结合专科能力建设与病种结构优化,探索基于病种/术种的医用耗材标准路径及使用规范,建立“一科(专科)一策、一术(术种)一策、一耗(耗材)一策”的专项耗材使用分析及改进措施,通过贯彻载药栓塞微球的使用论证、召开多部门整改会议、严控载药栓塞微球使用适应症、限制载药栓塞微球研究路径开展人员、对进口载药栓塞微球进行谈判降价等措施,实现入组经导管肝动脉栓塞术的出院患者在病例组合指数(CMI)均值从2.23升至2.34(P<0.001)的前提下,次均耗材费用从1.96万降至1.56万(P<0.001),可为全国同行提供决策参考和工作借鉴。Effective cost control and structure optimization of medical consumables in public hospitals can facilitate a shift from extensive cost control to scientific and refine management.On the premise of ensuring medical quality,reducing the burden of patients’diagnosis and treatment and meeting the actual needs of hospital management,this approach aims to realize valuable healthcare outcomes.This study was conducted in a tertiary hospital,which balanced both the medical and economic value of medical consumables.Using an integrated approach to specialty capacity building and disease structure optimization,the hospital restructured the use of medical consumables in Transcatheter Arterial Embolization(TAE)procedures.It developed standardized pathways and usage protocols tailored to specific diseases and surgical requirements.A targeted consumable usage policy framework was introduced,comprising“one department,one policy;one surgery type,one policy;and one consumable,one policy.”This included initiatives such as validating the use of drug-loaded embolic microspheres,conducting multi-departmental review meetings,strictly regulating indications for these microspheres,limiting personnel involvement,and negotiating reduced pricing on imported microspheres.Following implementation,the average case-mix index(CMI)for discharged patients undergoing TAE increased from 2.23 to 2.34(P<0.001),while the average per-case cost of consumables decreased from 19600 to 15600(P<0.001).These measures offer valuable decision-making and operational reference for hospitals nationwide,supporting efficient,quality-focused consumables management.

关 键 词：公立医院 高质量发展 医用耗材 成本管控 经导管肝动脉栓塞术 

分 类 号：R197.39[医药卫生—卫生事业管理] R197.32[医药卫生—公共卫生与预防医学]