摘要
目的了解我院医保高血压患者抗高血压药物使用情况和医保拒付情况。方法查阅本院综合内科2011年1~8月期间应用抗高血压药物的出院医保患者的北京市医疗保险结算清单68份,对高血压药物的用药品种,使用金额,使用甲、乙类药品,联合用药情况,使用高血压药品占本次住院药品比例等情况进行分析。查阅门诊医保拒付通报表,对其中高血压患者医保拒付情况进行分析,并提出减少医保拒付的对策。结果我院医保住院高血压患者抗高血压药物应用频次中,排名前3位的依次是钙离子拮抗剂、肾上腺素受体阻滞剂和血管紧张素受体拮抗剂。我院高血压药物销售金额前3位的为富马酸比索洛尔片、硝苯地平控释片和缬沙坦。我院门诊医保高血压患者医保拒付原因依次是累计开药超量、申报数量有误、超医保支付范围的药品、超医保药品目录限制、单次开药超量。结论我院医保高血压患者使用抗高血压药物情况基本合理,但是门诊医保患者存在少数拒付情况,需加强医保监管。
Objective To understand the medication and medical insurance non-payment situation of the insured patients with hypertention in our hospital.Methods 68 copies of Beijing medical insurance clearing lists of the discharged insured patients who received antihypertensive drugs from January to August in 2011 in the integrated internal medicine department of our hospital were reviewed.The variety and cost of antihypertensive drugs,use of type A and type B drugs,combined medication situation,the proportion of antihypertensive drugs to the total drugs during this hospitalization,etc.were analyzed.Through reviewing the outpatient medical insurance non-payment statements,the medical insurance non-payment of patients with hypertension were analyzed and countermeasures to reduce medical insurance non-payment were proposed.Results Regarding to the application frequency of antihypertensive drugs,Calcium antagonists,adrenergic receptor blockers and angiotensin receptor blockers ranked the top three respectively.Regarding to the sales amount,Bisoprolol Fumarate Tablets,Nifedipine GITS and Valsartan ranked the top three respectively.The causes of outpatient medical insurance non-payment for patients with hypertension in our hospital were excess cumulative prescription,wrong report number,drugs outside the range of medical insurance payment,drugs outside the medical insurance drug catalog and excess single prescription.Conclusion The application of antihypertensive drugs to insure patients with hypertension is basically rational,but exists few non-payment cases,therefore it is necessary to strengthen the medical insurance regulation.
出处
《中国医药导报》
CAS
2012年第31期123-125,共3页
China Medical Herald
关键词
医保患者
抗高血压药物
医保拒付
Insured patients
Antihypertensive drugs
Medical insurance non-payment
