摘要
[目的]对上海市造口人费用负担、诊疗可及性等情况进行评价,探讨完善造口耗材医保支付政策的可行性。[方法]通过上海市医保数据库获取2012-2017年医保登记造口人的基本信息,及其在全市医保定点机构的交易记录,计算其造口耗材费用。通过方便抽样抽取造口人167名开展问卷调查,调查内容包括造口服务可及性、造口耗材使用情况及费用负担。统计分析采用Stata 13.0完成。[结果]2012-2017年上海市医保登记的造口人达到24845人,门诊共发生造口耗材费用5165.21万元,其中医保基金支付3597.85万元;造口人就诊集中在三级医院(89.21%~82.88%);造口人年均购买造口耗材花费2396.57元,其中门诊报销1317.34元。[结论]造口耗材门诊报销政策保障效果显著,造口服务可及性和便利性有待加强,建议进一步调整医保政策提高补偿力度。
Objective To systematically evaluate the expense burden and health service accessibility of ostomy patients in Shanghai so as to discuss the feasibility of adjusting medical insurance policy on ostomy medical supplies.Methods It collected basic data of medical insurance registration ostomy patients in Shanghai medical insurance database from 2012 to 2017,and transaction record in designated medical facilities in the city,calculated their ostomy medical supplies expenses.It also conducted questionnaire survey to 167 ostomy patients through convenient sampling,which included accessibility of ostomy services,usage condition of ostomy medical supplies and expense burden.The statistic and analysis was completed by Stata 13.0.Results From 2012 to 2017,the number of ostomy patients in medical insurance registration system accumulated to 24845,ostomy medical supplies costs were 51.65 million yuan in outpatient services,in which 35.98 million yuan was paid by medical insurance fund.Medical services of ostomy patients were concentrated in tertiary hospitals(89.21%~82.88%).Annul average expenditure of a ostomy patient on medical supplies was around 2396.57 yuan,in which 1317.34 was reimbursed by the medical insurance in outpatient services.Conclusions The reimbursement policy on ostomy medical supplies has effectively protected patients from financial risks.However,accessibility and convenience of ostomy services need to be strengthened.It is suggested to further adjust the medical insurance policy to increase compensation.
作者
朱碧帆
岳秋颖
李秀娟
贾洸怡
金春林
李芬
ZHU Bi-fan;YUE Qiu-ying;LI Xiu-juan;JIA Guang-yi;JIN Chun-lin;LI Fen(Shanghai Health Development Research Center/Shanghai Medical Information Center,Shanghai 200031,China;Central Hospital of Yongcheng,Shangqiu Henan 476600,China;Shanghai Municipal Healthcare Security Bureau,Shanghai 200125,China;Shanghai Municipal Medical Insurance Management Center,Shanghai 200041,China)
出处
《卫生软科学》
2020年第10期69-73,79,共6页
Soft Science of Health
基金
美国中华医学基金会-卫生系统研究与政策转化合作项目(14-190)
第四轮上海市公共卫生体系建设三年行动计划(2015-2017)-循证公共卫生与卫生经济学(15GWZK0901)。
关键词
造口术
医用耗材
费用负担
医保政策
ostomy
medical supplies
expense burden
medical insurance policy
