医用耗材取消加成对人工全膝关节置换术费用影响研究

Impact of cancelling medical consumables addition policy on cost of total knee arthroplasty

目的比较医用耗材加成取消前后人工全膝关节置换术(total knee arthroplasty,TKA)费用,为国家医疗政策改革提供参考。方法以2018年9月—2019年2月接受TKA治疗的患者作为研究对象,其中372例符合标准纳入研究。根据医用耗材取消加成时间节点(2018年12月24日)分为取消前和取消后两组,各186例。收集患者资料,包括性别、年龄、住院时间、疾病分类,以及各项治疗费用(诊疗费、检查费、化验费、材料费、麻醉费、床位费、护理费、手术费、药费和其他),分析取消加成前后各项费用及构成比变化情况。结果两组患者性别、年龄及疾病分类构成比较,差异均无统计学意义(P>0.05);医用耗材加成取消后患者住院时间较取消前明显延长(t=2.114,P=0.035)。医用耗材加成取消前后TKA总费用差异无统计学意义(t=0.214,P=0.831);与加成取消前比较,材料费明显降低,诊疗费、麻醉费、护理费、手术费明显增加(P<0.05);检查费、化验费、床位费、药费及其他费用基本保持稳定(P>0.05)。结论医用耗材取消加成后TKA总费用水平稳定,材料费占比显著降低,体现医务人员技术含量的诊疗费用占比显著提高,符合国家取消医用耗材加成政策预期。

Objective To compare the cost changes of total knee arthroplasty(TKA)before and after the cancellation of medical consumables addition,so as to provide reference for the national medical reform policy.Methods The patients treated with TKA between September 2018 and February 2019 were admitted as objects of study,and 372 of them met the selection criteria and were finally included in the study.According to the time node of cancelling the medical consumables addition(December 24,2018),all patients were allocated to pre-cancelling and post-cancelling groups(n=186).The clinical data of patients(gender,age,length of stay,disease classification),and various treatment costs(the costs of diagnosis and treatment,examination,laboratory,material,anesthesia,bed,nursing,operation,drug,and others)were collected.And the changes of various costs and proportions before and after cancelling the medical consumables addition were compared.Results There was no significant difference in gender,age,and disease classification between the two groups(P>0.05);the length of stay after cancelling the medical consumables addition was significantly longer than that before cancelling(t=2.114,P=0.035).There was no significant difference in the total cost of TKA before and after cancelling the medical consumables addition(t=0.214,P=0.831).Compared with that before cancelling the medical consumables addition,the cost of material was significantly reduced,and the costs of diagnosis and treatment,anesthesia,nursing,and operation were significantly increased(P<0.05);the costs of examination,laboratory,bed,drug,and others were basically stable,and the differences were not significant(P>0.05).Conclusion The total cost of TKA is stable,the proportion of material cost is significantly reduced,the proportion of diagnosis and treatment cost reflecting the technical content of medical staff is significantly increased,which is in line with the expectation of the national policy of cancelling the medical consumables addition.