四川省取消医用耗材加成对剖宫产患者住院费用的影响

Analysis of the Impacts of Medical Consumables Price Markup Reform on hospitalization expenses of Caesarean Section Patients in Sichuan Province

目的 对比取消耗材加成前后,某医院剖宫产术住院患者总费用及结构变化情况,为进一步优化患者费用结构、降低患者负担提供依据。方法 系统收集2018年1月1日至2019年12月31日成都市某三级医院剖宫产患者共3081例,通过倾向得分匹配在总体中匹配出无差异的子样本,利用描述性分析和t检验分析改革前后费用差异情况。结果 改革前后,患者例均住院费用分别为13878.97和14075.05元(P=0.260),无统计学差异;手术费用占比从45.35%增长至47.07%,卫生耗材费用占比从17.11%降至13.5%。结论 改革后患者医疗费用结构优化,但耗材费用仍是患者医疗费用的主要来源之一,需进一步分析更多种类病种的费用结构以全面评析政策效果,可以通过实施耗材集中带量采购等降低耗材价格。

Objective To evaluate change of caesarean section patients’ medical costs and cost composition after the medical consumables price markup reform in Sichuan province,with results in this study,to provide evidence for optimizing cost composition of patients,as well for reducing the financial burden of patients.Methods Totally 3091 caesarean section inpatients were collected in a tertiary hospital from January 1,2018 to December 31,2019.Propensity score matching was employed to obtain an undifferentiated subsample,descriptive analysis and t test were then used to analyze the differences in patients’ costs before and after the reform.Results After the reform,the average hospitalization cost was increased from 13878.97 to 14075.05 yuan but the difference shows no statistical significance(P=0.260).The proportion of surgery cost for each patient was increased from 45.35% to 47.07%,while the proportion of medical consumable cost decreased from 17.11% to 13.50%.Conclusion The reform has rebuilt composition of the medical costs for caesarean section patients,but the medical consumables expenses were still main source of medical costs for patients.More analysis of costs of other diseases should be conducted to comprehensively assess the influence of the reform.The price of consumables can be reduced by implementing centralized procurement of consumables.