某县实施基本药物制度引致的医保损益研究
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篇名: 某县实施基本药物制度引致的医保损益研究
TITLE:
摘要: 目的:探索基本药物制度实施引致的某县医保损益及损益率。方法:以我国西部某县为样本地区,采用现场调查法收集2009-2015年该县基层医疗卫生机构(包括乡镇卫生院和村卫生室)门诊和住院人次、门诊和住院收入、药品收入、总住院日数据和医保报销标准等。以2009年为基准年,模拟测算未实施基本药物制度时的医保报销药品费用,通过与实际发生的医保报销药品费用进行比较,来计算医保的损益及损益率。结果:以样本县全面落实基本药物制度的2012年为界,2010-2011年,该县内基层医疗机构药品费用的医保报销表现为损失(损失金额分别为43.7万、91.5万元),在2012-2015年表现为得益(得益金额分别为19.9万、49.4万、85.8万、129.0万元),损益率从-0.67%上升到1.21%。而报销门诊药费和住院药费的医保损益变化趋势不同;报销村卫生室药费和乡镇卫生院药费的医保损益变化趋势有所不同。结论:基本药物制度的实施能给该县带来医保得益,节省了医保费用。
ABSTRACT: OBJECTIVE: To explore losses and gains (L&G) and L&G ratio induced by Essential Medicine System in a county. METHODS: By choosing a county in western China as sample area, field investigation was used to collect outpatient and inpatient visits, outpatient and inpatient income, drug income, total length of stay and medical insurance reimbursement criteria in primary medical institutions (township health centers, village health rooms) of the county during 2009-2015. By setting the year 2009 as the baseline year, the drug cost reimbursed by medical insurance was simulated and calculated when Essential Medicine System were not implemented; L&G and L&G ratio of medical insurance were calculated by comparing with actual drug cost reimbursed by medical insurance. RESULTS: The year 2012, in which the sample county fully implemented the Essential Medicine System was the turning year. Medical insurance funds lost in primary medical institutions of the county during 2010-2011(lost    437 000,915 000 yuan, respectively), but gained during 2012 to 2015(gained 199 000,494 000,858 000,1 290 000 yuan, respectively); the L&G ratio increased from -0.67% to 1.21%. For reimbursed outpatient drug cost and inpatient cost, L&G of medical insurance were different. For reimbursed drug cost of village health room and township health center, L&G of medical insurance were also different. CONCLUSIONS: The implementation of Essential Medicine System benefits to medical insurance within the county and Medical insurance funds can be saved.
期刊: 2018年第29卷第11期
作者: 白鸽,霍兆桦,何世英,张崖冰,李婉莹,周帅,曹晓琳,张天天,戴瑞明,周奕男,周良,熊雪晨,罗力
AUTHORS: BAI Ge,HUO Zhaohua,HE Shiying,ZHANG Yabing,LI Wanying,ZHOU Shuai,CAO Xiaolin,ZHANG Tiantian,DAI Ruiming,ZHOU Yinan,ZHOU Liang,XIONG Xuechen,LUO Li
关键字: 基本药物制度;县域;医保;损益
KEYWORDS: Essential Medicine System; County scope; Medical insurance; Losses and gains
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