实施临床路径及支付方式改革前后医疗费用变化分析:以剖宫产为例

Analysis on Change of Medical Cost for Inpatients with Caesarean Section in County Hospitals Before and after Introduction of Clinical Pathway and Case-based Payment

目的:评估临床路径及支付方式试点后剖宫产医疗费用变化。方法:调取2010年1月—2011年7月项目与对照医院试点前后全部剖宫产病例,应用倾向得分匹配法和倍差法来评价医疗费用效果。结果:试点后医院Q和H住院费用的变化不大;其药费比例分别下降5.82和8.13个百分点,材料费比例升高了6.83和3.02个百分点;医院Q自付比例下降了31.83个百分点(P﹤0.05)。结论:临床路径及支付方式改革试点使医疗费用趋于合理,并减轻患者经济负担。

Objective： To assess changes of medical cost for inpatients with caesarean section in county hospilals before and after introduction of clinical pathway and case-based payment. Method： All cases of caesarean section before and after the pilot were selected from both pilot and control hospitals. The medical cost-effectiveness are analyzed with PSM and DID. Results： After the pilot, the hospitalization costs of hospitals Q and H had not changed, the proportion of the drugs tees had been declined for 5.82 and 8.13 percentage points respectively, the proportion of materials fees had been declined for 6.83 and 3.02 percentage points respectively, and the proportion of out of pocket cost of hospital Q had been declined for 31.83 percentage points. Conclusion： The implementation of clinical pathway and payment method reform had made medical cost return to a reasonable level and reduced the economic burden of patients.