摘要
目的:以慢性心衰为例,研究新病种纳入门特门慢政策后对医保基金预算的影响,为决策提供参考。方法:基于我国医保视角,建立新病种纳入门特门慢后的医保预算影响分析方法,并以慢性心衰为例,选取我国某城市数据计算医保预算影响情况。结果:慢性心衰纳入该地区门特门慢后,综合考虑就诊率、用药方案、不良反应、住院率等指标的改变,预计每年可节省医保支出251-867万元左右。分析结果将随计算变量值的不同而变化。结论:本研究中,慢性心衰纳入门特门慢后,虽然增加了医药费用,但减少了住院费用,总体上节约了一部分医保基金支出。合理分析新病种纳入门特门慢后的预算影响,可预测基金支出变化情况并支持科学决策。
Objective:Explore the infl uence on medical insurance budget of a new disease enrolling in special and chronic disease outpatient management to help decision-making.Methods:Based on the perspective of medical insurance in China,a medical insurance budget impact analysis method for the enrollment of new diseases in special and chronic disease outpatient management was established.Taking chronic heart failure as an example,data of a Chinese city was selected to calculate the budget impact.Results:When chronic heart failure was included in special and chronic disease outpatient management in this region,it was estimated that it could save about 2.51-8.67 million yuan per year in medical insurance expenses after taking the changes in such indicators as consultation rate,medication plan,adverse reactions and hospitalization rate into account.The results would vary with variable changes.Conclusion:in this study,chronic heart failure increased medical costs but reduced hospitalization costs after special and chronic disease outpatient management was included.Overall,it would save medical insurance expenditure.A reasonable analysis of the budget impact of the new disease enrollment in special and chronic disease outpatient management can predict the change of fund expenditure and support decision-making.
作者
刘畅
陶立波
Liu Chang;Tao Libo(Health Policy and Technology Assessment Center,Peking University Health Science Center,Beijing,100191;Department of Health Policy and Management,Peking University Health Science Center,Beijing,100191)
出处
《中国医疗保险》
2020年第3期66-69,共4页
China Health Insurance
关键词
门特门慢政策
慢性心衰
预算影响分析
special and chronic disease outpatient management
Chronic Heart Failure
budget impact analysis
