DRGs实施前后温岭市肺癌患者就诊费用及个人负担比较

Comparison of healthcare expenditures and self-payment among patients with lung cancer in Wenling City before and after implementation of diagnosis-related groups(DRGs)

目的比较按病种付费(DRGs)实施前后温岭市肺癌患者就诊费用及个人负担的变化,为合理控制医疗费用、减轻患者负担提供依据。方法通过浙江省温岭市疾病预防控制中心癌症登记数据库和医保局门诊慢特病病种数据库,收集2015—2019年确诊的肺癌参保患者基本信息和就诊费用,比较DRGs实施前(2015—2016年)后(2018—2019年)肺癌患者门诊、住院费用和个人负担的变化情况。结果纳入肺癌参保患者4947例,其中男性3052例,占61.69%;女性1895例,占38.31%;年龄为(64.88±11.64)岁。2015—2016年年人均就诊费用为56675.85元,其中门诊费用占14.48%,住院费用占85.52%;2018—2019年年人均就诊费用为38702.94元,较2015—2016年减少31.71%,其中门诊费用占24.49%,住院费用占75.51%。2018—2019年门诊、住院和总体个人负担率分别为25.38%、32.49%和29.67%,低于2015—2016年的50.84%、50.96%和50.95%,差异均有统计学意义(χ^(2)=13.741,P<0.001;χ^(2)=7.015,P=0.008;χ^(2)=9.340,P=0.002)。结论DRGs实施后,肺癌参保患者年人均就诊费用和个人负担率降低。

Objective To investigate the healthcare expenditures and self-payment among patients with lung cancer in Wenling City before and after implementation of diagnosis-related groups(DRGs),so as to provide the evidence for con⁃trolling medical costs and relieving burdens of patients with lung cancer.Methods The basic data and healthcare ex⁃penditures of lung cancer patients that were definitively diagnosed from 2015 to 2019 and covered by medical insurance were captured from the cancer registration database of Wenling Center for Disease Control and Prevention and the data⁃base of chronic and specific diseases in Wenling Bureau of Medical Insurance.The changes of outpatient expenditures,inpatient expenditures and self-payments were compared before(2015-2016)and after implementation of DRGs(2018-2019)among lung cancer patients.Results Totally 4947 lung cancer patients covered by medical insurance were en⁃rolled in this study,including 3052 males(61.69%)and 1895 females(38.31%),with a mean age of(64.88±11.64)years.The annual mean healthcare expenditure was 56675.85 Yuan per capita during the period between 2015 and 2016,in which 14.48%were outpatient expenditures and 85.52%were inpatient expenditures,and the annual mean healthcare expenditure was 38702.94 Yuan per capita during the period between 2018 and 2019(a 31.71%reduction as compared to that in 2015 and 2016),in which 24.49%were outpatient expenditures and 75.51%were inpatient ex⁃penditures.The proportions of outpatient expenditures,inpatient expenditures and total self-payments consisted of 25.38%,32.49%and 29.67%of total healthcare expenditures in 2018 and 2019,which were significantly lower than those(50.84%,50.96%and 50.95%,respectively)in 2015 and 2016(χ2=13.741,P<0.001;χ2=7.015,P=0.008;χ2=9.340,P=0.002).Conclusions The annual mean healthcare expenditures per capita and the proportion of self-payment reduce among lung cancer patients covered by medical insurance following implementation of DRGs.