取消药品加成对脑卒中患者费用和质量的影响研究

The Effect of Zero Markup Drug Policy on the Cost and Quality among Stroke Patients

目的探索2017年4月我国东部某市取消药品加成后脑卒中住院患者医疗费用与医疗质量的变化。方法选取该市城镇职工医疗保险数据库2014年-2018年全部脑卒中住院病例,通过stata MP14.0软件进行描述性和线性回归分析。结果共纳入78208例脑卒中住院患者。改革后,脑卒中住院患者次均总费用、药品费用、耗材费用、住院时长、30 d再入院率显著下降(P<0.01),次均医生服务费用、护士服务费用、检查费用显著上升(P<0.01)。结论取消药品加成政策的实施,对降低医疗总费用、调整费用结构、缩短平均住院日有明显改善。未来应更关注患者出院评估,实行按绩效付费的支付制度,整合各级医疗资源,与价格调控政策形成合力,共同改善脑卒中医疗质量。

Objective To explore the changes of medical expenses and medical quality of stroke inpatients after zero markup drug policy in a city in eastern China in April 2017.Methods All hospitalized stroke cases from 2014 to 2018 were selected from the Urban Employee Basic Medical Insurance(UEBMI)database for descriptive and linear regression analysis using Stata MP14.0 software.Results A total of 78208 inpatients with stroke were included.After the reform,the average total cost per admission,drug cost,consumable cost,length of stay and 30-day readmission rate of stroke inpatients decreased significantly(P<0.01),while the doctor service cost,nurse service cost and examination cost increased significantly(P<0.01).Conclusion The zero-markup drug policy significantly reduced the total medical expenses,adjusted the cost structure and shortened the average length of stay.In the future,more attention should be paid to patient discharge evaluation,a pay-for-performance payment system should be implemented,and medical resources at all levels should be integrated to form synergy with price regulation policies to jointly improve the quality of stroke medical care.