| 许 轲,杨 剑,邱亭林.应用中断时间序列分析肿瘤患者住院费用变化趋势[J].中国肿瘤,2022,31(5):374-379. |
| 应用中断时间序列分析肿瘤患者住院费用变化趋势 |
| Application of Interrupted Time Series to Analyze the Trend of Hospitalization Expenses of Cancer Patients |
| 投稿时间：2022-03-09 |
| DOI：10.11735/j.issn.1004-0242.2022.05.A009 |
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| 中文关键词: 住院费用 疾病诊断相关分组 中断时间序列 医药分开综合改革 医耗联动综合改革 肿瘤患者 肿瘤医院 北京 |
| 英文关键词:hospitalization expense diagnosis related groups (DRGs) interrupted time series analysis clinic-pharmacy separation reform medical-consumable expenditure linkage reform cancer patient cancer hospital Beijing |
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| 中文摘要: |
| 摘 要：［目的］ 以疾病诊断相关分组（DRGs）中“胸部大手术不伴合并症与伴随病”组（EB15）为例，分析北京市医药分开和医耗联动综合改革前后肿瘤患者住院费用的变化情况，探讨政策实施效果。［方法］ 采用描述性分析和中断时间序列方法，分析北京市医药分开和医耗联动两轮改革对肿瘤医院EB15组患者住院费用的影响。［结果］ 两轮医改EB15组患者平均住院总费用稳中有降，其中药品费（占比减少9.10%）和耗材费（占比减少3.41%）占比下降幅度较大，医疗费（占比增加12.74%）和手术费（占比增加11.22%）占比上升幅度较大。中断时间序列分析结果显示，平均住院总费用在两轮医改后均瞬时下降，增速由改革前的较快增长（增长625.37元/月），转为缓慢增长（增长126.22元/月），再呈较快下降趋势（下降741.87元/月）。各类费用随医改政策变化不一，其中医药分开改革后，医疗费（瞬时增长971.22元，之后下降17.92元/月）和护理费（瞬时增长414.46元，之后下降9.45元/月）均瞬时增长，但之后呈缓慢降低趋势；药品费瞬时大幅下降7 166.71元，之后保持平稳；耗材费持续增涨（由改革前增长526.90元/月降低至27.32元/月），但增速大幅放缓。医耗联动改革后，药品费（瞬时下降3 057.57元，之后下降420.91元/月）和耗材费（瞬时下降6 892.43元，之后下降326.67元/月）均瞬时大幅下降，并保持下降趋势；医疗费（瞬时增长7 384.60元）和手术费（瞬时增长6 746.43元）均瞬时大幅增长，之后保持平稳。［结论］ 北京市医药分开和医耗联动综合改革的实施有效控制了EB15组患者住院费用的快速增长，肿瘤患者疾病负担逐步降低，住院费用结构不断得到优化，医务人员的劳动价值逐步得到体现，整体上达到改革预期目标。 |
| 英文摘要: |
| Abstract：［Purpose］ To analyze the impact of comprehensive medical reform on the hospitalization expenses of cancer patients in Beijing. ［Methods］ Using the major thoracic surgery without complications and concomitant diseases group (EB15) in diagnosis-related groups (DRGs) as an example， the changes of hospitalization expenses before and after comprehensive reform of clinic-pharmacy separation and medical-consumable expenditure linkage were analyzed with interrupted time series methods.［Results］ The average total hospitalization expenses of patients in the EB15 group after the two rounds of medical reform was stable with slight decline. Among them， the proportion of medicines and consumables decreased by 9.10% and 3.41%， respectively， while the proportion of medical and surgical expenses increased by 12.74% and 11.22%， respectively. The results of the interrupted time series analysis showed that the average total hospitalization expenses decreased instantaneously after the two rounds of medical reform. The growth patterns changed from the rapid growth(increased by 625.37 Yuan per month) before the reform to the slow growth(increased by 126.22 Yuan per month)， and then showed a rapid downward trend(decreased by 741.87 Yuan per month). Various types of fees varied with medical reform policies. After the reform of clinic-pharmacy separation， medical expenses instantaneously increased by 971.22 Yuan， then decreased by 17.92 Yuan per month； nursing expenses instantaneously increased by 414.46 Yuan， then decreased by 9.45 Yuan per month， but then showed a slow downward trend； medicines expenses dropped sharply in an instant(decreased by 7 166.71 Yuan)， and then remained stable； and the growth rate of consumables expenses slowed down significantly(from the monthly increase of 526.90 Yuan before the reform to 27.32 Yuan). After the reform of medical-consumable expenditure linkage， the expenses of medicines instantaneously decreased by 3 057.57 Yuan， then decreased by 420.91 Yuan per month； and consumables instantaneously decreased by 6 892.43 Yuan， then decreased by 326.67 Yuan per month. Medical expenses instantaneously increased by 7 384.60 Yuan and surgical expenses instantaneously increased by 6 746.43 Yuan)， then remained stable. ［Conclusion］ The implementation of the comprehensive reform of clinic-pharmacy separation and medical-consumable expenditure linkage in Beijing has effectively controlled the rapid growth of hospitalization expenses of cancer patients in the EB15 group. The disease burden of cancer patients has been gradually reduced， the structure of hospitalization expenses has been continuously optimized， the labor value of medical staff has been gradually reflected， and the expected goal of the reform has been initially achieved. |
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