【摘要】 目的 根据人工膝关节假体集采前后医保住院费用，分析高值耗材集中带量采购政策对医保住院费用、基金支付情况的影响，为评价政策实施效果提供参考。方法 通过医院病案信息系统检索住院膝关节置换患者病案资料，其中2021年5月1日-2021年10月31日人工膝关节假体集采前住院膝关节置换患者共纳入68例，2022年5月1日-2022年10月31日人工膝关节假体集采后住院膝关节置换患者共纳入88例。比较分析两组患者的住院总费用、材料费用、药品费用、手术费用、住院天数以及基金支付情况的均值差异，同时通过结构变动度分析法分析住院费用结构变化情况。结果 人工膝关节假体集采实施前后，例均住院总费用由48 210.2元降至30 847.1元，例均材料费用由28 924.6元降至8689.9元，分别下降36.1%和70.0%，例均个人支付费用由21728.3元降至13124.6元，例均医保基金支付费用由26481.9元降至17 722.5元，分别下降39.6%和33.1%，患者平均术前住院日由2.8天增加至3.9天。结构变动度分析结果显示集采后材料费用结构变动值呈负向变化，且对住院费用结构变动贡献率较集采前明显下降(28.9%)。结论 人工膝关节假体集采后人工假体费用和患者个人支付费用及医保支费用均显著下降，还需通过缩短术前住院日、完善配套服务以巩固集采成效。更多还原

【Abstract】 Objective This study aims to analyze the impact of the centralized procurement policy of high-value consumables on the medical insurance hospitalization expenses and fund payment according to the medical insurance hospitalization expenses before and after the centralized procurement of artificial knee prosthesis, so as to provide a reference for evaluating the effect of policy implementation. Methods The medical records of inpatients with knee replacement were searched and screened through the medical record information system. Among them, a total of 68 patients with knee joint replacement hospitalized before the centralized procurement of artificial knee joint prostheses from May 1, 2021 to October 31, 2021 were included. From May 1, 2022 to October 31, 2022, a total of 88 inpatients with knee replacement after the collection of artificial knee prostheses were enrolled. Comparative analysis was performed to analyze the mean differences in total hospitalization costs, material costs, drug costs,surgery costs, hospital days, and fund payments between the two groups. Meanwhile, the structure change of hospitalization expenses was analyzed by the method of structure change degree analysis. Results Before and after the implementation of centralized procurement of artificial knee prostheses, the total hospitalization expenses per case decreased from 48,210.2 yuan to 30,847.1 yuan, and the average material cost per case decreased from 28,924.6 yuan to 8,689.9 yuan, a decrease of 36.1% and 70.0% respectively. The average personal payment fee per case dropped from 21,728.3 yuan to 13,124.6 yuan, and the average medical insurance fund payment fee per case dropped from 26,481.9 yuan to 17,722.5 yuan, down 39.6% and 33.1% respectively. The average preoperative hospital stay increased from 2.8 days to 3.9 days. The results of the structure change degree analysis showed that the change value of material cost structure after centralized procurement showed a negative change, and the contribution rate to the structural change of hospitalization expenses decreased significantly(28.9%) compared with that before centralized procurement. Conclusions The cost of artificial knee prostheses, the cost of personal payment of patients, and the cost of medical insurance have all decreased significantly after the centralized procurement of artificial knee prostheses. It is also necessary to shorten the preoperative hospital stay and improve supporting services to consolidate the effectiveness of centralized procurement.更多还原