医保制度改革对脑卒中康复产生的影响及效果

The influence and effect of reform of medical insurance system on rehabilitation of patients with cerebral apoplexy

[目的]探讨2021年广州市调整实行《医疗保险及生育保险医疗服务价格项目目录》(简称“新目录”)后对脑卒中康复产生的影响及效果。[方法]采用广州某医院康复中心新目录实行前、后1年时间内,脑卒中患者的住院天数、住院费用、康复费用、自付费用、康复疗效、患者流向等横截面数据进行分析。[结果]患者出院后流向三级医院的病例由改革前的280例(83.58%)减少至改革后的194例(61.20%);流向二级/基层医院的病例由改革前的53例(15.82%)增加至改革后的102例(32.18%);流向社区医院或回家的病例由改革前的2例(0.60%)增加至改革后的21例(6.62%);出院流向的差异具有统计学意义(Z=46.328,P<0.001)。实行新目录提升了脑卒中患者的康复疗效及满意度。平均住院天数较前增多11%,平均住院总费用较前增多5%,平均康复费用较前增多11%,平均自付费用并没有明显增加。[结论]实行改革后,该院脑卒中患者向基层医院流动增多,有利于引导医疗资源优化配置;脑卒中患者的住院天数的增加,使其康复治疗的需求得以释放,有利于脑卒中患者康复治疗;脑卒中后遗症患者的住院费用和自付费用呈现出增长的趋势。

Objective To explore the influence and effect on rehabilitation of patients with cerebral apoplexy after the adjustment and implementation of the Catalog of Medical Service Price For Medical Insurance and Maternity Insurance(referred to as the“New Catalogue”)in Guangzhou in 2021.Methods Cross-sectional data such as hospitalization days,hospitalization costs,rehabilitation costs,out-of-pocket costs,rehabilitation efficacy and whereabouts of patients with cerebral apoplexy were analyzed before and after the implementation of the New Catalogue in a rehabilitation center of a hospital in Guangzhou.Results The number of patients flowing to tertiary hospitals decreased from 280(83.58%)before the reform to 194(61.20%)after the reform.The number of cases flowing to secondary/primary hospitals increased from 53(15.82%)before the reform to 102(32.18%)after the reform.The number of cases flowing to community hospitals or going home increased from 2(0.60%)before the reform to 21(6.62%)after the reform.The difference in discharge flow was statistically significant(Z=46.328,P<0.001).The implementation of the New Catalogue has improved the rehabilitation efficacy and satisfaction of patients with cerebral apoplexy.The average length of hospitalization days increased by 11%.The average total hospitalization costs increased by 5%.The average rehabilitation costs increased by 11%.Average out-of-pocket expenses did not increase significantly.Conclusions After the implementation of the reform,patients with cerebral apoplexy flow to grass-roots hospitals more,which is conducive to the optimal allocation of medical resources.The increase of hospitalization days of patients with cerebral apoplexy has released the demand for rehabilitation treatment,which is conducive to the rehabilitation treatment of patients with cerebral apoplexy.The hospitalization expenses and out-of-pocket expenses of patients with cerebral apoplexy show an increasing trend.