摘要
目的:分析职工医保门诊共济制度实施对中医类与非中医类医院医药费用的差异影响。方法:使用2022—2023年兰州市高血压门诊患者医保结算数据,运用单因素分析和间断时间序列模型进行实施前后比较。结果:中医类医院实施前后的次均西药费、中草药费和医疗服务项目费,差异均有统计学意义(P<0.05),且次均医疗费总额、中草药费和医疗服务项目费实施后呈现明显下降趋势(P<0.05);非中医类医院实施前后的次均医疗费总额、西药费、中成药费等,差异均有统计学意义(P<0.05),且次均医疗费总额、西药费和中成药费实施后呈现明显下降趋势(P<0.05)。结论:职工医保门诊共济制度对两类医院医药费用控制产生有利影响,且非中医类医院费用控制效果更优,但部分组成费用控制效果有待加强。要持续完善职工医保门诊共济制度,推进多方协同治理与支付差异化,以提升门诊待遇保障水平。
Objective:To analyze the effects of the employee medical insurance outpatient mutual assistance system implemented on medical and pharmaceutical costs between traditional Chinese medicine(TCM)and non-TCM hospitals.Methods:Using medical insurance settlement data for hypertensive outpatients in Lanzhou from 2022 to 2023,univariate analysis and interrupted time-series models were implemented to compare changes before and after the implement.Results:In TCM hospitals,there were statistically significant differences in the average per-visit costs of Western medicines,Chinese herbal medicines,and medical service items before and after the implement(P<0.05).Additionally,the average per-visit total medical costs,Chinese herbal medicine cost,and medical service item cost all showed a significant downward trend after the implement(P<0.05).In non-TCM hospitals,the differences in the average per-visit total medical costs,Western medicine cost,proprietary Chinese medicine cost and other items before and after the implement were statistically significant(P<0.05).Furthermore,the average per-visit total medical costs,Western medicine cost,and proprietary Chinese medicine cost showed a significant downward trend after the implement(P<0.05).Conclusion:The employee medical insurance outpatient mutual assistance system has had a positive impact on controlling medical and pharmaceutical costs in both types of hospitals,with non-TCM hospitals showing better cost control outcomes.However,the control of certain cost components in both types of hospitals still requires further improvement.It is essential to continuously refine the employee medical insurance outpatient mutual assistance system,promote multi-stakeholder collaborative governance,and implement differentiated payment strategies to enhance the level of outpatient benefit protection.
作者
陈蒙恩
王焱
张晓溪
袁有树
侯浩佳
王佳怡
杨敬宇
王志伟
张倩
Chen Meng'en;Wang Yan;Zhang Xiaoxi(School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing,102400,China;School of Management,Beijing University of Chinese Medicine,Beijing,102400,China;不详)
出处
《中国卫生经济》
北大核心
2025年第12期13-18,共6页
Chinese Health Economics
基金
甘肃省医疗保障局2022年课题委托项目
国家中医药管理局资助项目(ZYZB-2023-435、GZY-FJS-2022-045)。
关键词
职工医保门诊共济制度
中医类医院
非中医类医院
医药费用
双组间断时间序列模型
employee medical insurance outpatient mutual assistance system
traditional Chinese medicine hospitals
Non-traditional Chinese medicine hospitals
medical and pharmaceutical costs
two-group interrupted time-series model
