关键词: 结核,肺, 费用,医疗, 卫生政策, 模型,统计学

Abstract:

Objective:To analyze the changes in hospitalization costs of tuberculosis inpatients before and after the implementation of the drug markup abolition policy. Methods:This study was a retrospective study with data obtained from the medical insurance settlement system of Luzhou City, Sichuan Province. The billing data of tuberculosis inpatients hospitalized from February 1, 2015 to November 20, 2018 in two Grade A tertiary tuberculosis designated hospitals (Affiliated Hospital of Southwest Medical University and Luzhou People’s Hospital) were obtained, and a total of 3749 cases were included. Interrupted time series (ITS) model was used to analyze the changes in the level and trend of the average total hospitalization cost and costs under different categories before and after the implementation of the drug markup abolition policy. Results:The average age of 3749 tuberculosis inpatients was (48.23±18.90) years, and the largest number of tuberculosis patients had a total single hospitalization cost of RMB 10000-14999 yuan per patient which accounted for 26.25% (984/3749) of all patients. After the implementation of the abolition of the drug markup policy, the median total cost of a single hospitalization was decreased by RMB 1150.13 yuan, and the median cost of a single western medicine was decreased by RMB 643.16 yuan. ITS analysis showed that before the implementation of the abolition of the drug markup policy, the average traditional Chinese medicine cost and average material cost increased by 5.34% (β₁=0.052, t=2.941, P<0.05) and 1.92% (β₁=0.019, t=3.987, P<0.05) per month on average. At the time of policy implementation, the average anesthesia, material and traditional Chinese medicine costs immediately increased by 83.31% (β₂=0.606, t=3.311, P<0.05), 24.48% (β₂=0.219, t=2.477, P<0.05), and 99.57% (β₂=-0.691, t=-2.187, P<0.05) respectively. After the implementation of the drug markup abolition policy, the average monthly decrease in the average traditional Chinese medicine, material, western medicine, examination, anesthesia, surgical costs, and the average total hospitalization cost were 0.60% (β₁=0.052, β₃=-0.058, t=-2.193, P<0.05), 4.81% (β₁=0.019, β₃=-0.066, t=-10.051, P<0.05), 1.51% (β₁=0.003, β₃=-0.018, t=-2.223, P<0.05), 2.53% (β₁=0.009, β₃=-0.034, t=-4.552, P<0.05), 4.39% (β₁=0.003, β₃=-0.046, t=-3.373, P<0.05), 4.92% (β₁=0.009, β₃=-0.057, t=-3.057, P<0.05) and 1.31% (β₁=0.006, β₃=-0.019, t=-4.432, P<0.05), respectively. Conclusion:After the implementation of the abolition of the drug markup policy, the total hospitalization cost and drug cost of tuberculosis inpatient showed a decreasing trend, indicating that the policy of abolishing drug markup had made a significant influence in reducing drug costs and controlling total hospitalization cost of tuberculosis patients.

Key words: Tuberculosis,pulmonary, Fees,medical, Health policy, Models,statistical