Objective To study the use of real-world evidence by EU and its member states for establishing a strategy for rare diseases and provide references for the inclusion of orphan drugs in China’s medical insurance.Method...Objective To study the use of real-world evidence by EU and its member states for establishing a strategy for rare diseases and provide references for the inclusion of orphan drugs in China’s medical insurance.Methods A case analysis method was used to introduce the EU’s decision to include rare disease drugs in medical insurance by using real-world evidence because clinical data of rare diseases were difficult to obtain.Results and Conclusion China can use real-world evidence to make medical insurance decisions based on the experience of the EU and continue to invest more in rare diseases,which can solve the problem of few drugs for patients with rare disease.展开更多
目的探讨疾病诊断相关分组(diagnosis related groups,DRG)和按病种分值付费(diagnosis-intervention packet,DIP)融合下设立医院临床路径的方法,并分析其实际效果。方法选取2021年3月—2023年6月山东第一医科大学第二附属医院收治的阑...目的探讨疾病诊断相关分组(diagnosis related groups,DRG)和按病种分值付费(diagnosis-intervention packet,DIP)融合下设立医院临床路径的方法,并分析其实际效果。方法选取2021年3月—2023年6月山东第一医科大学第二附属医院收治的阑尾炎接受腹腔镜下阑尾切除术者。其中观察组纳入268份病历,对照组纳入270份病历。对照组阑尾炎患者采取临床路径入组,观察组实施DRG与DIP融合下的综合管理路径进行管理,统计2组临床路径入组情况,比较2组次均药物、耗材、总住院费用以及2组住院时间及病种医保结余费用,分析2组时间及费用消耗指数变化情况。结果观察组临床路径入组例数为263例,多于对照组的217例,临床路径完成率为98.13%,高于对照组的80.37%(P<0.05)。观察组次均药物费用、耗材费用及总住院费用均显著低于对照组(P<0.05)。观察组总住院时间低于对照组,病种医保结余费用多于对照组(P<0.05)。观察组时间消耗指数和费用消耗指数均显著低于对照组(P<0.05)。结论DRG与DIP融合下临床路径管理可提高临床路径入组率,降低医疗费用,缩短总住院时间,降低医保支付费用。展开更多
在按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费方式改革大潮中,中医特色和价值优势没有得到充分体现。南京市自2022年起开创中医DRG分组付费方式,改革成效亟须系统性评估。从服务可及性、质效可靠性、费用可控性三个维度对...在按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费方式改革大潮中,中医特色和价值优势没有得到充分体现。南京市自2022年起开创中医DRG分组付费方式,改革成效亟须系统性评估。从服务可及性、质效可靠性、费用可控性三个维度对南京市中医DRG分组付费改革效果进行评估,结果表明,政策实施后,纳入中医DRG分组付费的中医特色病种在服务可及性、质效可靠性、费用可控性上总体呈现出明显优势。机构覆盖率、病组覆盖率和病组病例数均明显增长,中医医疗服务质量和效率明显增强,医保基金对纳入中医DRG分组付费的中医特色病种的倾斜支持力度逐年上升。南京市中医DRG分组付费改革经验主要体现在病证结合、科学编码、就高倾斜和数据赋能等方面,但仍存在分组方案不均衡、证候分型管理有待加强和疗效价值体现不明显等不足。未来,建议进一步扩大DRG分组付费范围,提升服务可及性;协同加强医疗机构院内管理,提升质效可靠性;强化中医医保支付政策引导,提升费用可控性;探索中医疗效价值评价体系,提升支付效能度。展开更多
Reimbursement policy for outpatient chronic diseases is an important part of the basic medical insurance scheme in China. The reimbursement policy for outpatient chronic diseases in basic medical insurance for urban r...Reimbursement policy for outpatient chronic diseases is an important part of the basic medical insurance scheme in China. The reimbursement policy for outpatient chronic diseases in basic medical insurance for urban residents of provincial capitals in China were analyzed from the perspectives of disease types, benefits package, qualification and health service access. Proposals to improve policy design, establish standardized disease inclusion criteria and set reasonable benefits package, strengthen management and complete supporting policy, strengthen policy coordination were put forward according the existing problems such as fragmented policy, great difference in disease types and benefit package, supervision difficulty, incomplete policy framework and lack of policy coordination.展开更多
文摘Objective To study the use of real-world evidence by EU and its member states for establishing a strategy for rare diseases and provide references for the inclusion of orphan drugs in China’s medical insurance.Methods A case analysis method was used to introduce the EU’s decision to include rare disease drugs in medical insurance by using real-world evidence because clinical data of rare diseases were difficult to obtain.Results and Conclusion China can use real-world evidence to make medical insurance decisions based on the experience of the EU and continue to invest more in rare diseases,which can solve the problem of few drugs for patients with rare disease.
文摘目的探讨疾病诊断相关分组(diagnosis related groups,DRG)和按病种分值付费(diagnosis-intervention packet,DIP)融合下设立医院临床路径的方法,并分析其实际效果。方法选取2021年3月—2023年6月山东第一医科大学第二附属医院收治的阑尾炎接受腹腔镜下阑尾切除术者。其中观察组纳入268份病历,对照组纳入270份病历。对照组阑尾炎患者采取临床路径入组,观察组实施DRG与DIP融合下的综合管理路径进行管理,统计2组临床路径入组情况,比较2组次均药物、耗材、总住院费用以及2组住院时间及病种医保结余费用,分析2组时间及费用消耗指数变化情况。结果观察组临床路径入组例数为263例,多于对照组的217例,临床路径完成率为98.13%,高于对照组的80.37%(P<0.05)。观察组次均药物费用、耗材费用及总住院费用均显著低于对照组(P<0.05)。观察组总住院时间低于对照组,病种医保结余费用多于对照组(P<0.05)。观察组时间消耗指数和费用消耗指数均显著低于对照组(P<0.05)。结论DRG与DIP融合下临床路径管理可提高临床路径入组率,降低医疗费用,缩短总住院时间,降低医保支付费用。
文摘在按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费方式改革大潮中,中医特色和价值优势没有得到充分体现。南京市自2022年起开创中医DRG分组付费方式,改革成效亟须系统性评估。从服务可及性、质效可靠性、费用可控性三个维度对南京市中医DRG分组付费改革效果进行评估,结果表明,政策实施后,纳入中医DRG分组付费的中医特色病种在服务可及性、质效可靠性、费用可控性上总体呈现出明显优势。机构覆盖率、病组覆盖率和病组病例数均明显增长,中医医疗服务质量和效率明显增强,医保基金对纳入中医DRG分组付费的中医特色病种的倾斜支持力度逐年上升。南京市中医DRG分组付费改革经验主要体现在病证结合、科学编码、就高倾斜和数据赋能等方面,但仍存在分组方案不均衡、证候分型管理有待加强和疗效价值体现不明显等不足。未来,建议进一步扩大DRG分组付费范围,提升服务可及性;协同加强医疗机构院内管理,提升质效可靠性;强化中医医保支付政策引导,提升费用可控性;探索中医疗效价值评价体系,提升支付效能度。
文摘Reimbursement policy for outpatient chronic diseases is an important part of the basic medical insurance scheme in China. The reimbursement policy for outpatient chronic diseases in basic medical insurance for urban residents of provincial capitals in China were analyzed from the perspectives of disease types, benefits package, qualification and health service access. Proposals to improve policy design, establish standardized disease inclusion criteria and set reasonable benefits package, strengthen management and complete supporting policy, strengthen policy coordination were put forward according the existing problems such as fragmented policy, great difference in disease types and benefit package, supervision difficulty, incomplete policy framework and lack of policy coordination.
