广州市门慢政策的调整对职工医保癫痫患者就诊情况和医疗费用的影响研究

Effect of Guangzhou outpatient chronic disease policy adjustment on the burden of employee patients with epilepsy

目的研究门慢政策调整对市职工癫痫医保患者医疗服务利用的影响,为医保支付限额的上调提供参考。方法以广州两家三甲专科医院和一家三甲综合医院为研究对象,采集2014年1月至2017年12月共804例参与门慢政策的职工医保癫痫患者电子病历(EMR)信息,对比职工门慢政策调整(2016年1月1日)前后癫痫患者医疗费用及疾病治疗情况的变化。结果门慢政策调整后,职工患者门诊就诊次数提高了25%,次均门诊自付费用降低了21%,住院比例下降了37.58%,次均住院的自付费用增长了82.36%,用药天数增加了12.45%,奥卡西平的用药比例由97.51%降低至26.02%。结论不同的医疗保险政策会诱发患者产生不同的医疗行为,从广州市职工门慢政策调整前后癫痫参保患者就诊情况的变化说明,支付限额的上调对门诊服务有较好的引导作用和费用控制效果。门诊就诊次数的提高在一定程度上降低住院比例,特别是对于癫痫这种慢性病,促进门诊服务的利用,有助于延缓疾病的发展进程,降低住院比例。

Objective To study the effect of the outpatient chronic disease policy adjustment on medical treatment,and provide reference for increase of medical insurance payment limits.Methods The Electronic Medical Records(EMR)information of 804 patients with epilepsy participated in the outpatient chronic disease policy were collected from three hospitals in Guangzhou from January 2014 to December 2017,and the disease treatment and medical expenses of these patients were analyzed before and after the policy adjustment on January 1,2016.Results After the adjustment of the policy,the utilization rate of outpatient services was increased by 25%,the average payment of outpatient service was reduced by 21%,the hospitalization rate was decreased by 37.58%,and the average expense of hospitalization was increased by 82.36%.The number of days of medication was increased by 12.45%,and the proportion of oxcarbazepine was decreased.Conclusion Different medical insurance policies will induce patients to have different medical behaviors.The changes in the treatment of epileptic patients before and after the adjustment of the policy show that the increase of the payment limit has a good guiding role and cost control effect on outpatient services.The increase of outpatient visits can reduce the proportion of inpatients to a certain extent,especially for chronic disease epilepsy.The enhanced use of outpatient services can help delay the development of the disease and reduce the proportion of inpatients.