国家药品集中带量采购政策对住院患者医疗费用的影响研究

A Study on the Impact of National Volume-based Procurement on Inpatient Medical Costs

目的:研究国家药品集中带量采购(以下简称集采)政策对住院患者医疗费用产生的影响。方法:对样本医院集采药品的完成情况进行描述性分析,利用落实政策前后的住院患者医疗费用数据,对患者医疗费用的结构变化进行统计,以使用集采药品的首日时间为断点,构建精确断点回归模型,比较不同费用类别的变化情况。结果:样本医院部分集采药品的使用情况还存在进步空间,使用集采药品后,除综合服务类费用及耗材类费用分别上升了1.01和3.07个百分点外,其余各类别费用均呈现下降趋势,住院患者人均医疗总费用和人均药品费用分别下降了644.58元和300.19元。断点回归结果进一步显示,集采政策显著降低了样本医院住院患者的医疗总费用、药品费用及西药费。此外,患者平均住院日得到有效缩短。结论:国家集采政策取得了一定成效,但需要制定更合理的采购量指标,同时综合调整控费措施,进一步优化医疗费用的结构。

Objective:To study the impact of the national volume-based procurement policy on inpatient medical costs.Methods:Firstly, a descriptive analysis on the completion of the procurement volume of drugs in the hospital was carried out, and furthermore,using the data on the medical costs of inpatients before and after the implementation of the policy, conducted statistics on changes in the structure of patients' medical expenses. Taking the time of the first day of using the volume-based procurement drugs as the breakpoint, a sharp regression discontinuity model was constructed to compare the changes in the different categories of costs.Results:There is still room for improvement in the use of volume-based procurement drugs in the hospital. After the use of those drugs,in addition to the cost of comprehensive services and consumables rose by 1.01 and 3.07 percentage points respectively, the rest of the categories of costs were on a downward trend, the per capita total medical costs and drug costs of inpatients fell by 644.58 yuan and 300.19 yuan respectively. In addition, the average hospital stay of patients decreased significantly after the implementation of the policy.Conclusion:The national volume-based procurement policy has achieved certain results, but there is a need to set more reasonable procurement volume targets and to adjust cost control measures in a comprehensive manner to further optimize the structure of medical costs.