【摘要】 目的:2011年10月南通市医疗保险中心降低了部分抗肿瘤药品的自付比例,本研究评价该政策对肿瘤患者医疗费用的影响,为控制医疗费用增长提供政策建议。方法:整群随机抽取使用过自付比例降低抗肿瘤药品的患者数据,描述性分析抗肿瘤药品价格和医疗费用,建立计量经济模型评价其实施效果。结果:降低抗肿瘤药品个人自付比例后,品牌药和通用名药品的价格都有不同程度的下降,次均住院费用和药品费用增加,个人自付费用及自付比例降低。回归结果发现,肿瘤患者的次均住院个人自付费用降低了54.5%(P<0.001),个人自付比例降低了12.5个百分点(P<0.001),次均住院药品费用增加了35.9%(P<0.001)。品牌药使用是影响住院费用的重要因素。结论:医保部门应在总额控制或病种支付的前提下,制定医保药品目录报销的多层价格机制,引导居民合理使用药物,提高医保基金的使用效率。更多还原

【Abstract】 Objective:The medical insurance center decreased part of the self-pay ratio of anti-neoplastic drugs in October,2010.The study evaluated the policy impact on the medical costs for cancer patients so as to provide policy suggestions for controlling the growth of medical costs.Methods:The inpatients employed the anti-neoplastic drugs were randomly selected by clustering sample from Nantong health insurance database.Descriptive analysis was performed the prices of anti-neoplastic drugs and medical costs.The econometric model was built to evaluate its implementation result.Results:After decreasing the individual self-pay ratio of anti-neoplastic drugs,the prices of branded drugs and general drugs decreased in varying degrees,average per time hospitalization expenditure and drug expenditure increased,individual self-pay expense and self-pay ratio decreased.According to the regression result,the average per time individual self-pay expense of cancer patients decreased by 54.5%(P<0.001),the individual self-pay ratio decreased by 12.5%(P<0.001),the average per time hospitalization drug costs increased by 35.9%(P<0.001).The utilization of branded drug was the important factor influencing the hospitalization expenses.Conclusion:Under the control of the global budget payment or case-based reimbursement,healthcare department should design multi-layer price mechanism of medical insurance drug catalogue reimbursement,guide the residents’ rational utilization of drugs and improve the efficiency of medical insurance fund.更多还原