基于同病同效同价的典型中医优势病种疗效与费用分析  

Analysis on the curative effect and cost of typical TCM dominant diseases based on the same disease with same effect and same price

作　　者：张惠文 楚天舒 张诗文[1] 李宇涵 荆丽梅 ZHANG Huiwen;CHU Tianshu;ZHANG Shiwen;LI Yuhan;JING Limei(Shanghai University of Traditional Chinese Medicine,Shanghai 201203,P.R.China;Shanghai Jiao Tong University,Shanghai 200030,P.R.China;Shanghai Geriatrics Center,Shanghai 201104,P.R.China;Fudan University,Shanghai 200032,P.R.China)

机构地区：[1]上海中医药大学,上海201203 [2]上海交通大学,上海200030 [3]上海市老年医学中心,上海201104 [4]复旦大学,上海200032

出　　处：《中国循证医学杂志》2024年第11期1249-1254,共6页Chinese Journal of Evidence-based Medicine

基　　金：国家医保局首都医科大学国家医疗保障研究院开放性课题(编号:YB2023B08);上海市卫生经济学会科研项目(编号:HXZZ09)。

摘　　要：目的在推进中医支付方式改革同病同效同价原则下,分析使用西医或中医治疗的疗效和费用差异,为中医优势病种支付方式改革提供卫生经济学依据。方法收集典型地区2020年至2021年4家中医院和4家同等级的西医院病案首页数据,聚焦消渴、颈椎病、腰痹和盆腔炎四种典型中医优势病种,通过倾向性得分匹配共纳入14958例病例,比较同病同效同价假设下两组病例的年龄、床日数、总费用、出院情况、90天同病种再手术情况。结果典型中医优势病种中腰痹、消渴、颈椎病患者老年人比例高;同病同效比较中医治疗组的出院情况均显著优于西医治疗组;90天同病种再手术率,消渴中医效果较优,盆腔炎西医效果较优,腰痹、颈椎病两组无显著差异;同病同价比较中,腰痹、颈椎病西医治疗总费用较高,消渴中医治疗总费用较高,盆腔炎两组无统计学差异;同病同效同价比价中,颈椎病与盆腔炎西医治疗治疗费用较高,消渴与腰痹中医治疗费用较高。结论典型中医优势病种中医治疗的总体疗效更好,腰痹、消渴中医治疗同病同效时费用更低,盆腔炎总体费用未显著增长的同时实际住院天数下降,能够提升医院效率和降低患者间接成本,体现了中医优势病种改革的必要性。此外,老年慢性病在中医优势病种的发展中有较大需求,可作为中医优势病种改革的关注重点。Objective Under the principle of promoting the reform of TCM payment methods,analyzing the difference in efficacy and cost of treatment using Western medicine or traditional Chinese medicine,and providing health economics basis for the reform of payment methods for advantageous diseases of TCM.Methods Data from the first page of medical records of 4 Chinese hospitals and 4 western hospitals of the same level were collected from 2020 to 2021 in typical areas,focusing on four typical TCM advantageous diseases that were consistent with diabetes,cervical spondylosis,arthralgia syndrome in the lumbar area or pelvic inflammation,and a total of 14958 cases were included through propensity score matching.Under the assumption of same disease,same effect and same price,the age,bed days,total cost,discharge condition and reoperation condition of the same disease in 9o days were analyzed and compared between the two groups.Results In terms of outcomes,the experimental group showed significantly better discharge outcomes compared with the control group for the four diseases.In terms of cost,the control group had higher total costs for arthralgia syndrome in the lumbar area and cervical spondylosis,while the control group had lower total costs for diabetes.After controlling for treatment effects,the control group had higher costs for cervical spondylosis and pelvic inflammatory disease compared to the experimental group,while the control group had lower costs for diabetes and arthralgia syndrome in the lumbar area compared to the experimental group.Conclusion The experimental group shows better treatment effectiveness for the four TCM-dominant diseases.The control group has higher costs for cervical spondylosis and pelvic inflammatory disease when discharge outcomes are limited,while the control group has lower costs for diabetes and arthralgia syndrome in the lumbar area.This highlights the necessity of reforming the payment methods for TCM-dominant diseases.Additionally,the development of TCM-dominant diseases should focus o

关 键 词：中医优势病种 费用分析 疗效分析 卫生经济评价 

分 类 号：R1[医药卫生—公共卫生与预防医学]