住院患者高值医用耗材使用实证分析与策略建议

An Analysis of Inpatient Use of High-Value Medical Consumables for Policy-Making

本研究通过分析多个城市医院2014~2016年住院患者抽样数据中的高值医用耗材使用情况,为制订高值医用耗材管理政策提供实证依据。分析结果显示,各地医用耗材管理缺乏统一目录,高值医用耗材使用频次不大但使用费用高,呈现“量小费高”的特点。住院费用中,高值耗材费用占比逐年增长,对医保基金的影响日趋增加。高值耗材的使用病种具有聚集性,高值耗材费用占住院费用比例较高的疾病主要为心脏及周围血管疾病、骨关节疾病和各类先天畸形等。最后建议通过建立统一的高值医用耗材标准目录和规范、加强高值医用耗材重点监管、开展卫生技术评估、推进以DRGs为主导的按病种付费等手段,进一步促进高值医用耗材的合理合规使用。

The study analyzed the use of high-value medical consumables by hospitalized patients among a sample of 18 hospitals in China from 2014-2016 in order to provide evidence for policy making in the management of such consumables.There was lack of standardized list for such consumables between hospitals.Analysis results showed that the inpatient use of high-value medical consumables had several key features.The frequencies of use of high-value medical consumables were low while their costs were high.The proportion of costs of high-value medical consumables among total inpatient costs kept growing,and placed an increasing impact on healthcare security fund.Diseases with top costs of high-value medical consumables usage showed up in clusters,involving heart and peripheral vascular diseases,osteoarticular diseases,congenital malformation diseases and so on.It was suggested that establishment of standardized list for high-value medical consumables,strengthened monitoring for the use of such consumables,health technology assessment and DRGs-based payments should be conducted to further optimize the proper use of high-value medical consumables.