宁夏药品招标采购对参保和自费病人住院费用的影响

The Impact of Druge Purchase by Public Bidding on Medical Expenses of Insurance and Self-paid In-patients in Ningxia

目的比较医疗机构药品招标采购制度执行后对参保住院病人医疗费用的影响,寻找决定住院总费用上涨的主要收费项目。方法比较2006—2007年度,由公办的24所二级综合医院前10位病种的病案资料中,参保与自费住院病人药品招标前后医疗费用的变化情况以及各项费用对住院总费用的影响。结果参保病人住院平均天数(12d)高于自费病人(8d),Z=33.271,P<0.001;参保病人住院医疗费用是自费病人的2.26倍(Z=59.607,P<0.001)。药品统招后药品费用呈负增长,参保病人组药品费用平均减少47.5元,递减3.33%,自费病人组药品费用平均减少37.0元,递减6.69%。多因素分析:药品费用、其它费用的减少是住院医疗费用下降的主要因素,而床位费、护理费、实验室检查费、手术费是造成住院医疗费用增加的主要因素。结论完善医疗保险制度的监管机制,以有效降低医疗费用;药品招标后需注意床位费、护理费、实验室检查费、手术费用对患者住院费用上涨的影响。

Objective To compare the impact on medical expenses of the medical insurance in-patients before and after druge purchased by public bidding in Ningxia, to find the main charge items which cause the increase of the total cost of in-patients and to provide information for further deepening the reform of the Medical Security System. Methods Information was collected from cases of statistical data of 10 anterior diseases in 24 public levelⅡ Hospitals from 2006 to 2007 and comparison of the changes of in-patient medical expenses before and after drug purchased by public bidding and the impact of the main charge items on the total cost of hospital were analyzed. Results After the druge purchased by public bidding , the average hospitalized days in insurance in-patients was 12 days and it was significantly higher than that in self-paid in-Patients （8 days, Z = 33. 271, P 〈 0.001 ）. Expenses of insurance in-Patients was 2.26 times as expenses of Self-paid in-Patients in 10 anterior diseases（ Z = 59.607, P 〈 0.001）. After public bidding, drug expenses in insurance in-patients were average reduced 47.5yuan（-3.33%） and they were reduced 48yuan（-6.69% ） in self-paid in-patients . Multi-factor analysis showed ： Major factors of reducing hospital costs were drug costs reduction, other cost reduction and increase of bed charges, nursing cost, laboratory cost, surgical cost caused the rising of hospital costs. Conclusion In order to effectively control the rising of hospital costs, it is important to improve the medical security system monitoring measures. Increasing of bed charges, nursing cost, laboratory cost, surgical operations cost were major factors affecting the rising of hospital costs.