人工晶状体国家集中带量采购政策对医保住院费用的影响

An analysis of the influence of national volume-based purchasing policy of intraocular lens on hospitalization expenses of medical insurance patients

目的 本文基于广州市某三甲医院人工晶体植入术单病种医保住院费用,分析高值耗材集中带量采购政策对医保住院费用、基金支付情况的影响,评价政策实施效果。方法 采用独立样本T检验法比较分析政策实施前后两组数据中住院总费用、晶体材料费用、药品费用、手术费用等费用明细以及基金支付情况的均值差异。结果 政策实施后,次均住院总费用及晶体材料费用分别下降21. 46%和60. 08%,患者平均个人支付费用降低了52. 00%,医保基金支付率提高了13. 57%。结论 国家集中带量采购政策在控制医疗费用方面效果显著,国家在全面推进带量采购模式的同时,要完善医疗价格体系、医保支付制度等配套措施,充分发挥公立医院内部管理的作用,以达到政策的可持续发展。

Objective This article aimed at analyzing the implementation effect of national volume-based purchasing policy of high-valued medical consumables.Methods Using independent-samples T test to compare and analyze the differences of the hospitalization expenses and medical insurance payouts before and after the implementation of the volume-based purchasing policy of intraocular lens in Guangdong Province.Results After the implementation of the policy,the average hospitalization expenses and intraocular lens fee decreased by 21.46%and 60.08%respectively,the out-of-pocket expenses of the insured was reduced by 52.00%,and the rate of reimbursement improved 13.57%.Conclusion As an effective measurement on cost control,the national volume-based purchasing policy of high-valued medical consumables could be promoted throughout the nation.At the same time,the government should attach importance to the supporting measures such as medical service price system and medical insurance policies,in order to maintain the sustainable development.