贵重医疗器械纳入医保对医院医保费用影响研究

Research on the impact of the medical insurance costs in hospital when the expensive medical consumables were putinto insurance catalogue

目的 分析贵重医疗器械纳入医保后医院医保费用变化的原因，为积极探索支付方式改革提供建议和参考。方法 对上海市8家三级医院2009年1月～2011年12月城保患者费用信息采用一般描述性统计，并采用配对秩和检验的方法 对政策调整前后的医生对待医保患者和自费患者的行为变化进行比较．选取某医院5个科室的医患双方进行调查问卷。结果 政策调整后所研究贵重器械的国产化率由35．00％下降至26．26％；65．71％的患者倾向于进口材料，81．25％的医生和62．86％的患者倾向于限价支付：模拟医保限价支付后，提高材料的10％～30％的国产化率可以使患者自负费用由19046．38元逐步下降至2124．80元，而医保支付费用的下降比例为10．19%～38．42％。结论 分析结果 客观反映了限价支付方式的优势，是支付方式改革的方向。

Objective To analyze the causes of the changes of the medical insurance costs in hospital when the expensive medical consumables were put into the insurance catalogue, and to provide advice and reference actively to the payment reform. Methods Description statistics analysis of the expense from the patients of medical insurance for urban workers was adopted by the eight urban tertiary hospitals from January 2009 to December 2011. Wilcoxon signedrank test was also adopted by the hospitals to compare the changes of the doctor＇s treatments between medicare patients and patients at one＇s own expense. The questionnaire investigation was conducted among the doctors and patients from five departments in a chosen hospital. Results The results showed that the nationalization rate of the expensive medical consumables fell from 35.00% to 26.26% after the policy adjustment; 65.71% of the patients tended to use imported consumables; 81.25% of the doctors and 62.86% of the patients tended to have the limit pay for the using of the equipment. After conducting simulated medicare limit pay policy, the 10% to 30% increase in domestic production rate decreased the amount of patient＇s out of pocket expenses from 19 046.38 yuan down to 2124.80 yuan, subsequently, the medicare expense dropped from 10.19% to 38.42%. Conclusion The results reflect the benefits of ration payment form and it may be the direction of the payment reform.