摘要
背景北京同仁医院在社区开展为期十年三个阶段糖尿病规范化管理,对患者进行规范化、连续性跟踪管理。患者接受长期管理后,实际产生的效果是否具有经济效益和社会效益,尚未开展实证性卫生经济学评估。目的选取部分社区开展实地调研,了解在接受管理的社区中,糖尿病患者的社区各年度门诊费用情况(真实世界数据)。方法根据项目实际情况,干预项目前两个阶段的社区中,对其中9个社区参加项目的患者随机抽取30%的人员,自2016年11月起对其开展为期10个月的卫生经济学费用现场调查,分别调取入组患者2012、2014、2016年在社区卫生服务中心门诊就诊时产生的药品、检查等费用数据,对各年份费用数据通过Kruskal-Wallis H检验和描述性研究,对费用结构及用药情况等开展描述性研究。结果经消涨处理后,2012、2014、2016年人均门诊费用为10312.9、10885.6、11733.5元。结构分析中糖尿病诊疗费用糖尿病防治相关用药的整体年消耗水平为4690.4~5251.9元,约占年人均费用水平的44.76%~45.48%,其他费用和中药费用两者占据了近半数(47.31%~48.34%)。结论本干预模式下患者的用药情况和年度费用水平整体处于平稳状态,间接说明接受干预管理的糖尿病患者病况整体相对稳定;费用结构存在部分不合理,其他费用和中药费用两者的占比和增速存在一定的问题。建议建立主要慢性病病种的结构性精细化支付标准。在门诊慢性病支付方面,设立和控制辅助性用药的占比,并进一步分析辅助性中成药支出和其他支出的内涵,重新制定其相对合理的可支出占比。
Background Beijing Tongren Hospital has carried out a 10-year three-stage standardized community-based diabetes management program(hereinafter referred to as BCDS),aiming to provide community-dwelling diabetic patients with standardized and continuous follow-up management services.After long-term management,whether the actual effect has economic and social benefits has not been evaluated by empirical health economics.Objective To understand the annual outpatient diabetes care expenses in community health centers(CHCs)by analyzing the real-world data collected via a field investigation in CHCs implementing the BCDS.Methods We conducted a field investigation for 10 consecutive months since November 2016 using health economics method in 9 of the CHCs who have implemented the first and second stages of the Tongren diabetes program.One third of the diabetic patients receiving the program management were selected randomly,and data about their outpatient expenses in 2012,2014 and 2016,including drug and examination expenses,were collected.Kruskal-Wallis test and descriptive research were used to analyze the annual expenses.Descriptive research was conducted to analyze the cost of structure and drug use.Results After adjusting for inflation,the annual outpatient expenses per capita were 10312.91,10885.56,and 11733.50 yuan,respectively.The analysis of cost of structure found that,the annual cost of diabetes prevention and treatment related drugs ranged from 4690.37 to 5251.85 yuan,accounting for around 44.76%-45.48%of the annual expenses per capita.Traditional Chinese medicine expenses and other expenses accounted for nearly half of the total,about 47.31%-48.34%.Conclusion With the interventions of Tongren diabetes program,the drug use and annual outpatient expenses of diabetic patients are generally stable,indirectly indicating that the overall conditions of the intervened patients are relatively stable.The structure of the cost is partial irrationally,such as the proportion and growth rate of traditional Chinese medicine expenses and other expenses are not ideal,and use of too many types of Chinese patent medicines,and the ranking of the top 10 drugs(because their prophylactic and anti-diabetic effects are still unclear),which needs further improved.In view of this,we put forward the following recommendations:developing a structured and refined payment system for major chronic diseases;in terms of outpatient chronic disease payment,appropriately determining and controlling the proportion of expenses of auxiliary therapies;reasonably modifying the proportions of expenses of Chinese patent medicines as auxiliary therapies and other expenditures based on deeply analyzing their meanings.
作者
徐楠
王梅
刘晓东
顾雪非
李婷婷
袁申元
袁明霞
XU Nan;WANG Mei;LIU Xiaodong;GU Xuefei;LI Tingting;YUAN Shenyuan;YUAN Mingxia(Department of Health Security Research,China National Health Development Research Center,Beijing 100044,China;LKS Faculty of Medicine the University of Hong Kong,Hong Kong 999077,China;Department of Endocrinology,Beijing Tongren Hospital,Beijing 100730,China)
出处
《中国全科医学》
CAS
北大核心
2021年第16期2028-2033,共6页
Chinese General Practice
关键词
糖尿病
社区卫生服务中心
门诊费用
费用结构
医疗保障
Diabetes
Community health center
Outpatient expense
Cost structure
Medical security
