摘要
目的分析国家组织人工关节集中带量采购(以下简称人工关节集采)对全髋关节置换术患者住院费用的影响。方法以百色市某三级甲等公立医院为样本医院,采集该医院2021年1月至2022年10月接受全髋关节置换术的515例患者的病案首页数据,其中集采前(2021年1月至2022年3月)353例,集采后(2022年4—10月)162例。利用间断时间序列方法分析人工关节集采政策实施前后住院费用的变化,并在2022年10—12月和2023年7—8月对该院骨科科室主要负责人、业务骨干、医用耗材管理和医保管理人员等进行一对一无结构访谈,了解人工关节集采政策的执行情况、住院费用相应变化及其原因等。结果人工关节集采政策实施后,手术患者住院费用即刻下降22566元(P<0.001),长期趋势斜率变化无统计学意义(P=0.430)。从费用结构看,手术用一次性材料费用即刻下降26889元(P<0.001),长期趋势斜率改变量为-515元(P<0.001);手术治疗费用、非手术项目治疗费用和非手术用一次性医用材料费用即刻有不同程度增加(P<0.05),手术治疗费用和非手术用一次性医用材料费用的长期趋势斜率该变量为-637元/月和-372元/月(P<0.001),非手术项目治疗费用长期趋势斜率变化无统计学意义(P=0.196)。自付费用即刻下降7195元(P<0.001),长期趋势斜率变化无统计学意义(P=0.550)。访谈结果显示,集采后人工关节使用和手术情况总体变化不大,但存在配送延迟,且住院费用中部分费用指标的变化也与按疾病诊断相关分组支付方式改革相关。结论人工关节集采政策有效降低了全髋关节置换术患者的住院费用,费用结构更加优化,减轻了患者的经济负担,节约了医保基金支出。未来需要完善医保支付机制形成政策合力,提升集采政策效能,推动公立医院和医药服务高质量发展。
Objective To analyze the impacts of volume-based procurement(VBP)of artificial joints on the hospital costs for discharged patients who underwent total hip arthroplasty.Methods The discharge data of 515 total hip replacement patients at a tertiary public hospital in Baise city was collected,comprising 353 cases pre-VBP(January 2021 to March 2022)and 162 cases post-VBP(April to October 2022).Data was analyzed using interrupted time series method.Between October to December 2022 and July to August 2023,one-to-one unstructured qualitative interviews were conducted with the director,doctors,and nurses of the orthopedic department,as well as staffs of the medical equipment department and the health insurance office.The aim was to gather insights about the implementation details of the VBP policy for artificial joint implants,VBP policy's impact on hospitalization costs and its underlying causes.Results After the implementation of the VBP for artificial joint implants,the hospitalization expenses of surgical patients immediately dropped by 22566 yuan(P<0.001),but the change in the slope of the long-term trend was not statistically significant(P=0.430).From the perspective of cost structure,the cost of disposable surgical materials decreased immediately by 26889 yuan(P<0.001),with a long-term trend slope change of-515 yuan per month(P<0.001).Meanwhile,there were varying degrees of immediate increases in surgical treatment costs,non-surgical item treatment costs,and non-surgical disposable medical material costs(P<0.05).Specifically,the long-term trend slope for surgical treatment costs and non-surgical disposable medical material costs decreased by-637 yuan per month and-372 yuan per month,respectively(P<0.001).However,the long-term trend slope of non-surgical item treatment costs did not show statistical significance(P=0.196).The out-of-pocket expenses immediately decreased by 7195 yuan(P<0.001),but the change in the slope of the long-term trend was not statistically significant(P=0.550).The interview results showed that there were not much overall changes found in the use and surgeries of artificial joints after centralized procurement,but there were delivery delays,and the changes in some cost indicators of hospitalization expenses were also related to the reform of diagnosis related groups payment methods.Conclusions The implementation of VBP effectively reduced the hospitalization cost for total hip arthroplasty patients,primarily by decreasing artificial joint cost.In addition,it optimized the cost structure,alleviated the financial burden on patients and saved medical insurance expenditures.Future initiatives should focus on improving the medical insurance payment reform to form a policy synergy,creating a cohesive policy framework that enhances the effectiveness of VBP policy,thereby facilitating the high-quality development of public hospitals and medical services.
作者
林燕铭
农圣
郑芸
黄承夸
黄二丹
Lin Yanming;Nong Sheng;Zheng Yun;Huang Chengkua;Huang Erdan(School of Public Health,Peking University,Beijing 100191,China;School of Public Health and Management,Youjiang Medical University for Nationalities,Baise 533000,China;Department of Orthopaedics,Southwest Hospital Affiliated to Youjiang Medical University for Nationalities and Baise People's Hospital,Baise 533000,China;China National Health Development Research Center,Beijing 100836,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2023年第12期927-932,共6页
Chinese Journal of Hospital Administration
基金
国家自然科学基金(72164036)
广西自然科学基金(2020GXNSFAA238028)。
关键词
集中带量采购
人工关节
全髋关节置换术
住院费用
间断时间序列
Volume-based procurement
Artificial joint
Total hip arthroplasty
Hospital costs
Interrupted time series
