医保药品支付标准改革对定点医疗机构临床用药的影响——基于福建省省本级、福州市参保人员医疗费用的实证分析

The impact of medical insurance payment standard reform on clinical drug use in designated medical institutions: Based on Fujian provincial level,Fuzhou medical insurance insured personnel empirical evidence

目的:评估福建省医保药品支付标准改革对定点医疗机构临床用药的影响。方法:分析福建省省本级、福州市医疗保险管理中心331万参保人员2016年4~9月及上年同期门诊和住院药品消费数据,按年度统计药品费用、用药情况以及医保药品支付标准政策执行情况。结果:改革前后医保药品支付标准目录内费用占比从22.50%上升为64.95%;公立医院及非公立医院改革前后门诊药品前10位一致仅排序略有变化,改革后两者门诊支付标准内费用占门诊费用比例分别为73.21%、39.30%;公立医院住院前10位药品品种及其金额变化较大,其中联合采购价差较大的药品费用增幅较高,而非公立医院相对稳定。结论:医保药品支付标准改革显著影响了临床用药品牌选择和用药结构;以药品集中采购结合联合带量采购形成的医保药品支付标准有利于降低药品价格;医保药品支付标准改革结合医药卫生体制综合改革措施更有利于发挥引导作用。

Objective： To evaluate the influence of medical insurance payment standard reform on clinical drug use in designated medical institution. Methods： The medical expenses and drug consumption data of provincial level and Fuzhou medical insurance management center 3. 31 million is included from April to September of 2016 and the same period of last year were statistically analyzed. The annual drug cost,drug use and the payment standard of medical insurance analysis were performed according to the annual statistics. Results： Before and after the reform,the proportion of the payment of standard drugs increased from 22. 50% to 64. 95%. The top 10 outpatient drugs in public hospitals and non-public hospitals were changed only in serial number,and after the reform,the cost of outpatient service fee was 73. 21% and 39. 30% respectively. Meanwhile,the variety and amount of drugs changed greatly of top 10 drugs public hospitals. The increase in drug cost of drugs with joint purchasing price difference was higher,and non-public hospitals were relatively stable. Conclusions： As per the findings of this study,Medicare insurance payment standard reform has significantly affected the choice of drug brands and drug use structure. To focus on the medical insurance payment standard of concentrated purchase of drugs combined with the amount of joint procurement of medicines is beneficial to reduce drug prices. The medical insurance payment standard reform combined with comprehensive reform of medical and health system measures are much more conducive to play a guiding role.