某院重点监控药品基于处方前置审核系统的医保控费管理与实施效果评价

Medical Insurance Cost Control Management and Implementation Effect Evaluation of Key Monitored Drugs in Our Hospital Based on Pre-prescription Review System

目的:探讨本院智能化处方前置审核系统对重点监控药品的医保控费管理与实施效果评价。方法:统计干预前(2019年10~11月)、干预后(2020年10~11月)本院出院患者使用大株红景天注射液、注射用红花黄色素、注射用丹参多酚酸盐、注射用灯盏花素、斑蝥酸钠注射液、华蟾素胶囊、注射用辅酶Ⅰ7个重点监控药品的超医保限制用药情况和人均费用。结果:与干预前相比,干预后7个重点监控药品的平均超医保限制使用率减少率为72.41%,平均超医保限制用药金额减少率为77.62%,平均人均费用减少196.36元,个别品种人均费用有所增加。结论:基于处方前置审核系统的医保控费管理可进一步规范重点监控药品的合理使用,有效降低不合理的医保支出,具有推广实施的价值。

Objective:To explore the medical insurance cost control management and intervention effect evaluation of key monitored drugs in our hospital by intelligent pre-prescription review system.Methods:The beyond medical insurance limit situation and per capita cost of 7 key monitored drugs such as sofren injection,safflower yellow pigment for injection,salvianolate for injection,breviscapine for injection,disodium cantharidinate injection,cinobufagin capsule,and coenzyme I for injection used by the patients discharged from our hospital before intervention(October to November,2019)and after intervention(October to November,2020)were counted.Results:Compared with that before intervention,the average reduction rate of utilization rate of beyond the medical insurance limit of 7 key monitored drugs was 72.41%,the average reduction rate of consumption amount of beyond medical insurance limit was 77.62%,the average per capita cost decreased 196.36 Yuan,and the per capita cost of individual varieties increased after intervention.Conclusion:The medical insurance cost control management based on pre-prescription review system can further standardize the rational use of key monitoring drugs and effectively reduce unreasonable medical insurance expenditures.It has the value of promotion and implementation.