摘要
目的以冠脉支架为例,评估上海市胸科医院执行高值医用耗材集中带量采购政策的效果,对比分析集采前后冠脉支架使用情况及患者住院费用变化,找出政策执行中的问题并提出针对性对策,为高值医用耗材集中带量采购政策优化提供参考。方法以霍恩-米特模型为研究框架,选取2019—2024年共11707例经皮冠状动脉介入治疗的手术住院患者费用明细,采用中断时间序列分析(Interrupted Time Series,ITS)方法分析冠脉支架集中带量采购政策前后的支架使用情况。结果集采政策(2021年实施)后,住院患者数量年均下降12.40%,冠脉支架使用量年均降幅20.33%;均次手术耗材费用年均降幅8.66%,耗材费用占比年均下降16.66%;住院总费用年均上升9.16%,波动幅度较小。ITS显示,政策实施后冠脉支架月均使用量呈上升趋势(β1+β3=0.757,P>0.05),手术人数变化趋势略微下降(β1+β3=2.679,P>0.05)。结论冠脉支架集采政策在降低耗材费用、优化医疗费用结构、减轻患者经济负担方面成效显著,推动了医疗资源高效配置。为确保国家集采政策能够稳步前行,医疗机构需持续展现积极配合态度。同时,相关部门应严格把关产品质量,密切关注供货稳定性及临床需求适配性,持续提升高值医用耗材集中采购的科学性、合理性与可持续性,助力医疗保障体系高质量发展。
Objective To evaluate the implementation effect of the centralized volume-based procurement policy for high-value medical consumables at Shanghai Chest Hospital using coronary stents as an example,compare and analyze changes in coronary stent utilization and patients’hospitalization expenses before and after the policy implementation,identify problems in policy execution,and propose targeted countermeasures to provide references for optimizing the centralized volume-based procurement policy for high-value medical consumables.Methods Based on the Horn-Mitchell model,detailed hospitalization expense data of 11707 inpatients who underwent percutaneous coronary intervention(PCI)between 2019 and 2024 were collected.Interrupted time series(ITS)analysis was used to examine changes in coronary stent utilization before and after the implementation of the centralized volume-based procurement policy.Results After the policy was implemented in 2021,the annual number of inpatients decreased by 12.40%on average,and the annual utilization of coronary stents dropped by 20.33%on average.The average annual reduction in per capita surgical consumable expenses was 8.66%,and the proportion of surgical consumable expenses in total hospitalization expenses decreased by 16.66%annually.The total hospitalization expenses increased by 9.16%annually with a small fluctuation range.ITS analysis showed that the monthly average utilization of coronary stents showed an upward trend after the policy implementation(β1+β3=0.757,P>0.05),while the number of surgeries showed a slight downward trend(β1+β3=2.679,P>0.05).Conclusion The centralized volume-based procurement policy for coronary stents has achieved remarkable results in reducing consumable expenses,optimizing the structure of medical expenses,alleviating patients’economic burden,and promoting the efficient allocation of medical resources.To ensure the steady advancement of the national centralized procurement policy,medical institutions should continue to demonstrate a proactive attitude of cooperation.Meanwhile,relevant departments should strictly control product quality,closely monitor supply stability and adaptability to clinical needs,and continuously improve the scientificity,rationality,and sustainability of centralized procurement for high-value medical consumables,so as to facilitate the high-quality development of the medical security system.
作者
吴丝瑀
顾伟
李亚年
WU Siyu;GU Wei;LI Yanian(Procurement Center,Shanghai Chest Hospital/Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China;SPD Management Office,Shanghai Chest Hospital/Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China)
出处
《中国医疗设备》
2025年第12期137-144,共8页
China Medical Devices
关键词
高值医用耗材
集中带量采购
中断时间序列分析(ITS)
霍恩-米特模型
冠脉支架
政策评估
high value medical consumables
centralized volume-based procurement
interrupted time series(ITS)
Horn-Mitchell model
coronary stents
policy evaluation
