摘要
目的以人工膝关节为例,分析耗材集中带量采购和区域点数法总额预算和按病种分值付费(Diagnosis-Intervention Packet,DIP)方式改革后患者住院费用和医保结算金额变化情况,探讨集采与DIP关于控制就医费用的正向叠加效应,为DIP深化改革提供有益的参考。方法采用中断时间序列分析方法,获取2021年1月至2024年4月1064例患者病案首页的费用数据及医保结算数据,描述变量随政策的瞬时变化和长期变化趋势。结果集采政策实施前住院总费用和明细费用中的医疗与治疗费、诊断费和药品费均快速增长。集采后住院总费用、诊断费和医用材料费均瞬时降低(P<0.05),总费用以108.41元/月缓慢上升;医疗与治疗费及药品费瞬时变化不显著(P>0.05);患者自付金额和医保基金支付金额均瞬时降低(P<0.05),长期变化不显著;医院盈亏瞬时变化不显著(P>0.05),长期以816.15元/月上升。DIP与集采叠加实施后,住院总费用、诊断费和医用材料费瞬时变化不显著(P>0.05),总费用长期以54.78元/月缓慢下降;医疗与治疗费瞬时升高(P<0.05),长期以23.92元/月上升;药品费瞬时降低(P<0.05),长期变化不明显;患者自付金额瞬时增长834.29元(P<0.05),长期以10.48元/月缓慢下降;医保基金支付金额和医院盈亏瞬时变化不显著(P>0.05),长期分别以764.76元/月和723.33元/月快速下降。结论DIP与耗材集采在控制住院费用的正向叠加效应显著,对费用结构的优化有明显的促进效果,体现技术劳务价值的费用提升,药品费进一步下跌。患者就医负担降低,医保基金发挥战略性调控作用。针对诊断费增长、耗材费变化不显著和医院盈利空间收窄,需联合配套措施综合治理。
Objective Taking artificial knee joint as an example,to analyze the changes of hospitalization costs and medical insurance settlement amount of patients after the reform of the centralized procurement of consumables and diagnosis-intervention packet(DIP),and discuss the positive superposition effect of collection and DIP on controlling medical costs,so as to provide useful reference for deepening the reform of DIP.Methods The cost data and medical insurance settlement data from the first page of 1064 patients’medical records from January 2021 to April 2024 were obtained by using the interrupt time series analysis method,and the transient and long-term change trends of variables with policies were described.Results Before the implementation of the centralized procurement policy,the total hospitalization cost,as well as medical and therapeutic cost,diagnosis cost and drug cost in the detailed costs all increased rapidly.After the implementation of the centralized procurement policy,the total hospitalization cost,diagnosis cost and medical materials cost decreased instantaneously(P<0.05),and the total cost rose slowly at 108.41 yuan/month.The instantaneous changes of medical and therapeutic cost and drug cost were not significant(P>0.05).Patients’out-of-pocket payment and medical insurance fund payment decreased instantaneously(P<0.05),and the long-term change was not significant.There was no significant change in the instantaneous profit and loss of the hospital(P>0.05),and the long-term increase was at 816.15 yuan/month.After the combination of DIP and the centralized procurement policy,the total hospitalization cost,diagnosis cost and medical material cost had no significant changes(P>0.05),and the total cost decreased slowly at 54.78 yuan/month in the long run.The medical and therapeutic cost increased instantaneously(P<0.05),and increased in the long run at 23.92 yuan/month.The drug cost decreased instantaneously(P<0.05),and the long-term change was not obvious.The out-of-pocket payment of patients increased by 834.29 yuan in an instant(P<0.05),and slowly decreased by 10.48 yuan/month in the long run.The payment amount of medical insurance fund and the profit and loss of hospital had no significant change in the instant(P>0.05),and the long-term decrease was at 764.76 yuan/month and 723.33 yuan/month,respectively.Conclusion DIP and centralized procurement of medical consumables have significant positive superposition effect in controlling hospitalization costs,and have obvious promotion effect on the optimization of cost structure,reflecting the increase of the cost of technical labor service value and the further decrease of drug cost.The medical insurance fund plays a strategic role in reducing the patient’s medical burden.In view of the increase of diagnosis cost,the insignificant change of consumables costs and the narrowing of profit space of hospitals,joint supporting measures are needed for comprehensive treatment.
作者
范琳琳
FAN Linlin(Department of Medical Equipment,Affiliated Hospital of Jining Medical University,Jining Shandong 272029,China)
出处
《中国医疗设备》
2025年第2期89-95,共7页
China Medical Devices
基金
济宁市重点研发计划(软科学)项目(2024JNZC082)
国家卫生健康委医院管理研究所合作项目(20230616)
2020年院级“知行”课题项目(ZX-2020-020)。
关键词
区域点数法总额预算和按病种分值付费
集采
正向叠加效应
医用耗材
中断时间序列
住院费用
医保支付
diagnosis-intervention packet(DIP)
centralized procurement with volume
positive superposition effect
medical consumables
interrupt time series
hospitalization cost
medical insurance payment
