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基于医疗机构的 RWS 评价中国丙型肝炎医疗保险报销政策的实施效果。

Evaluation of the implementation effect of hepatitis C medical insurance reimbursement policy in China: A RWS based on medical institutions.

机构信息

West China School of Pharmacy, Sichuan University, Chengdu, China.

West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Front Public Health. 2023 Jan 11;10:1072493. doi: 10.3389/fpubh.2022.1072493. eCollection 2022.

Abstract

OBJECTIVES

To evaluate the implementation effect of hepatitis C medical insurance reimbursement policy in China from the view of medical institutions.

METHODS

The electronic medical record of a top tertiary hospital in Chengdu from January 2014 to December 2020 were extracted, and the interrupted time series model was used to analyze the changes in diagnosis and treatment behavior and disease burden of hepatitis C patients after the implementation of HCV insurance reimbursement policy.

RESULTS

In terms of diagnosis and treatment, the number of visits (β2 = 19.290, < 0.001) and treatments (β2 = 14.291, < 0.01) increased instantaneously after the implementation of the outpatient reimbursement policy in Chengdu in 2018, and there was no significant change after the implementation of the single line payment policy for oral direct antiviral (DAA) drugs in 2019 ( > 0.05); in terms of medical expenses, the total treatment cost (β2 = 21439.3, < 0.001), out-of-pocket expenses (β2 = 6109.44, < 0.001) and drug expenses (β2 = 21889.8, < 0.001) of hepatitis C patients have been significantly reduced after the implementation of the single-line payment policy.

CONCLUSION

Hepatitis C medical insurance reimbursement policy can promote hepatitis C patients to actively seek medical treatment, promote the widespread use of DAA scheme, reduce the burden of patients, and improve the treatment efficiency of hepatitis C.

摘要

目的

从医疗机构角度评价中国丙型肝炎医疗保险报销政策的实施效果。

方法

提取成都市某三甲医院 2014 年 1 月至 2020 年 12 月的电子病历,采用中断时间序列模型分析丙型肝炎医疗保险报销政策实施后丙型肝炎患者诊疗行为及疾病负担的变化。

结果

在诊疗方面,成都市 2018 年实施门诊报销政策后,就诊次数(β2=19.290,<0.001)和治疗(β2=14.291,<0.01)即刻增加,2019 年实施口服直接抗病毒药物(DAA)单药支付政策后无明显变化(>0.05);在医疗费用方面,丙型肝炎患者的总治疗费用(β2=21439.3,<0.001)、自付费用(β2=6109.44,<0.001)和药物费用(β2=21889.8,<0.001)在单药支付政策实施后均显著降低。

结论

丙型肝炎医疗保险报销政策可促进丙型肝炎患者积极就医,推动 DAA 方案广泛应用,降低患者负担,提高丙型肝炎治疗效率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cc4/9875004/afcda52c7cd4/fpubh-10-1072493-g0001.jpg

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