四川省城乡居民大病保险合规医疗费用界定研究(四)——2011年50家三级医疗卫生机构20种大病治疗用药分析

Research on the Definition of Compliance Medical Costs in Serious Illness Insurance of Ubran and Rural Residents in Sichuan Province(Ⅳ)——Analysis of the Medication for 20 Serious Illnesses in 50 Third Level Hospitals in 2011

目的:为进一步提高大病保险合规医疗费用的报销水平提供参考。方法:调查四川省50家三级医疗卫生机构2011年治疗20种大病的用药情况,包括用药品种、品规、使用金额等,并与现行"医保"药品目录和"新农合"用药目录进行对比。结果:共收集到该省50家三级医疗卫生机构治疗20种大病的药品使用信息50 551条,共涉及药品品规2 179种,品种1 723种。其中,涉及"医保"甲类664个品规、521种,采购金额3 179.14万元;乙类1 025个品规、795种,采购金额28 312.68万元;自费药品490个品规、407种,采购金额2 834.88万元。"新农合"目录内药品1 239个品规、938种,采购金额23 772.19万元;目录外药品940个品规、785种,采购金额10 554.51万元。"新农合"目录外药品的品规数、采购数量和采购金额均多于"医保"自费药品。全省采购药品和20种大病治疗用药中的自付药品占比基本相当。结论:该省三级医疗卫生机构治疗大病使用的自付药品情况符合全省医疗卫生机构挂网药品采购使用的一般规律;可将"医保"目录与"新农合"目录合并,并进一步研究20种大病治疗路径,经科学论证后将部分自付药品种纳入大病报销范围,以缓解大病患者费用支付负担。

OBJECTIVE：To provide reference for further improvement of compliance medical cost reimbursement of serious illness insurance in our province.METHODS：The use of the medicines for 20 serious illnesses in 50 third level hospitals in 2011 were investigated in respects of medicine types,specification,amount,etc.and then compared with＂Medical Insurance＂（MI）list and＂New Rural Cooperative Medical Scheme＂（NRCMS） list.RESULTS：Totally 50 551 purchasing messages about the medicines for 20 serious diseases were collected from 50 hospitals,which involved 2 179 specifications and 1 723 varieties.They involved 664 specifications and 521 varieties of MI A level medicine,amounting to 3 179.14 thousand yuan;1 025 specifications and 795 varieties of B level medicine,amounting to 28 312.68 thousand yuan;490 specifications and 407 varieties of self-paid medicines,amounting to 2 834.88 thousand yuan;1 239 specifications and 938 varieties of the medicines in NRCMS list,amounting to 23 772.19 thousand yuan;940 specifications and 785 varieties of the medicine out of the list,amounting to 10 554.51 thousand yuan.Specifications,purchasing quantity and amount of the medines out of NRCMS list were more than those of self-paid medicines in MI.CONCLUSIONS：The use of the medicines for serious illnesses in third level hospitals of our province obeys provincial general rule of the purchase and application of online medicines.MI list should be combined with NRCMS list.The reimbursement range of medicines for 20 serious illnesses should be further enlarged.Part of self-paid medicines are took into reimbursement range after scientific verification to lower the burden of patients with serious illness.