广州市医保门诊特殊慢病政策对某医院慢性乙肝患者诊疗状况的影响

Effect of Outpatient Special Chronic Disease Policy of Medical Insurance on the Diagnosis and Treatment of Patients with Chronic Hepatitis B in a Hospital in Guangzhou

目的:分析2015年1月广州市医保将慢性乙型肝炎(CHB)纳入门诊特殊慢病政策对患者诊疗情况的影响,为今后政策的制定提供参考依据。方法:采用倾向值匹配政策实施前后24个月的门诊CHB患者,比较政策实施前后2组患者的抗病毒药物使用率,HBV DNA转阴率以及各种治疗费用。结果:政策实施后,患者的总抗病毒药物使用率从69.31%上升至75.99%,而干扰素使用率下降(P=0.0001);HBV DNA累积转阴率高于政策实施前(χ~2=6.39,P=0.0115);医疗总费用增加,主要集中在抗病毒费用的增加上(P<0.05)。结论:门诊特殊慢病政策可提高CHB患者抗病毒药物的使用率,但并未降低患者费用,医保政策需实施更为精细化的管理。

Objective:To analyze the effect of Guangzhou medical insurance on the diagnosis and treatment of patients with Chronic Hepatitis B(CHB)after the inclusion of chronic hepatitis B in the outpatient special chronic disease policy in 2015,and to provide reference for the formulation of future policies.Methods:Propensity Score Matching was used to match outpatients with chronic hepatitis B for 24 months before and after the implementation of the policy.The use rate of antiviral drugs,HBV DNA seroconversion rate and various treatment costs were compared between the two groups before and after the implementation of the policy.Results:After the implementation of the policy,the total use rate of antiviral drugs increased from 69.31%to 75.99%,while the use rate of interferon decreased(P=0.0001).The Hepatitis B Virus DNA(HBV DNA)seroconversion rate of patients after the implementation of the policy was higher than that before the implementation of the policy(χ2=6.39,P=0.0115),the increase of total medical expenses mainly focused on the increase of antiviral expenses(P<0.05).Conclusion:Outpatient special chronic disease policy can increase the use of antiviral drugs in CHB patients,but does not reduce the cost of patients.Medical insurance policies need to be more sophisticated managed.