关键词: 糖尿病, 社区卫生服务中心, 门诊费用, 费用结构, 医疗保障

Abstract: Background　Beijing Tongren Hospital has carried out a 10-year three-stage standardized community-based diabetes management program（hereinafter referred to as BCDS），aiming to provide community-dwelling diabetic patients with standardized and continuous follow-up management services. After long-term management，whether the actual effect has economic and social benefits has not been evaluated by empirical health economics. Objective　To understand the annual outpatient diabetes care expenses in community health centers（CHCs） by analyzing the real-world data collected via a field investigation in CHCs implementing the BCDS. Methods　We conducted a field investigation for 10 consecutive months since November 2016 using health economics method in 9 of the CHCs who have implemented the first and second stages of the Tongren diabetes program. One third of the diabetic patients receiving the program management were selected randomly，and data about their outpatient expenses in 2012，2014 and 2016，including drug and examination expenses，were collected. Kruskal-Wallis test and descriptive research were used to analyze the annual expenses. Descriptive research was conducted to analyze the cost of structure and drug use. Results　After adjusting for inflation，the annual outpatient expenses per capita were 10 312.91，10 885.56，and 11 733.50 yuan，respectively. The analysis of cost of structure found that，the annual cost of diabetes prevention and treatment related drugs ranged from 4 690.37 to 5 251.85 yuan，accounting for around 44.76%-45.48% of the annual expenses per capita. Traditional Chinese medicine expenses and other expenses accounted for nearly half of the total，about 47.31%-48.34%. Conclusion　With the interventions of Tongren diabetes program，the drug use and annual outpatient expenses of diabetic patients are generally stable，indirectly indicating that the overall conditions of the intervened patients are relatively stable. The structure of the cost is partial irrationally，such as the proportion and growth rate of traditional Chinese medicine expenses and other expenses are not ideal，and use of too many types of Chinese patent medicines，and the ranking of the top 10 drugs（because their prophylactic and anti-diabetic effects are still unclear），which needs further improved. In view of this，we put forward the following recommendations: developing a structured and refined payment system for major chronic diseases；in terms of outpatient chronic disease payment，appropriately determining and controlling the proportion of expenses of auxiliary therapies；reasonably modifying the proportions of expenses of Chinese patent medicines as auxiliary therapies and other expenditures based on deeply analyzing their meanings.

Key words: Diabetes, Community health center, Outpatient expense, Cost structure, Medical security