医保费用定额支出干预对临床合理用药的影响

Effects of Restricting Medical Insurance Fees Expenditure on Rational Drug Use

目的:分析医保费用定额支出干预对临床合理用药的影响。方法:选取实施医保费用定额支出制度前后各1个月的临床用药资料,采用医疗机构合理用药评价指标中与住院费用密切相关的部分进行前后对比,分析实施医保费用定额支出干预对合理用药指标的影响。评价指标主要包括住院药占比、人均日住院药费、平均住院日、基本药物使用率以及抗菌药物使用各相关指标等。结果:实施医保费用定额支出制度后,全部用药指标均有一定程度的改善,其中改善较明显的主要有住院药占比由42.87%下降为37.86%;人均日住院药费由437.94元下降为293.16元,下降幅度达33.06%;基本药物使用率由40.32%上升为47.64%;人均抗菌药物费用由142.35元下降为106.28元,下降幅度达25.34%;抗菌药物使用强度(AUD)由58.04 DDDs/100人/天下降为49.15 DDDs/100人/天。结论:实施医保费用定额支出制度对控制医保统筹支出与药物费用不合理增长以及促进临床合理用药均有一定的现实意义。

OBJECTIVE： To analyze the effects of restricting medical insurance fees expenditure on rational drug use in the clinic. METHODS ： The data of drug use was selected one month before and after the implementation of restricting medical insurance fees expenditure system. The appraisal indexes of rational drug use in hospital were compared with the part that is close related to hospitalization fees. The effects of restricting medical insurance fees expenditure system on rational drug use were analyzed. Main appraisal indexes included drug ratio of hospitalization, per capita daily hospitalization drug cost, average hospitalization days, utilization ratio of essential medicines and some related indexes of antibiotics, etc. RESULTS： After the implementation of restricting medical insurance fees expenditure system, all drug use indexes were improved to a certain extent. The partial indexes were improved obviously： drug ratio of hospitalization decreased from 42.87% to 37.86%; per capita daily hospitalization drug cost decreased from 437.94 yuan to 293.16 yuan, decreasing by 33.06%; the utilization rate of essential medicines increased from 40.32% to 47.64% ; per capita antibiotics cost was decreased from 142.35 yuan to 106.28 yuan, decreasing by 25.34% ; DDDs of antibiotics decreased from 58.04 DDD/100 persons/day to 49.15 DDD/100 persons/day. CONCLUSIONS： The implementation of restricting medical insurance fees expenditure system is certain significance to controlling medical insurance planning as a whole expenditure, irrational increasing of drugs cost and promotion of rational drug use.