摘要
目的:收集近20年来国内外学者发表的按病种支付方式下肺结核患者补偿情况的研究,并进行循证医学分析,探寻支付方式对肺结核患者疾病经济负担的作用效果。方法:以"肺结核/结核病"和"支付方式"为关键词,从中国知网、PubMed等数据库检索文献,根据纳入排除标准,利用NoteExpress软件对文献进行筛选,采用RevMan5.3软件对符合条件的研究结果进行Meta分析。结果:305篇文献中,仅有10篇文献符合纳入标准,对报销比例这一结局指标进行循证医学分析得到的合并RR值为1.20,95%的可信区间为[1.11,1.30];对个人自付费用指标进行分析,SMD为-5.56,95%的可信区间为[-10.05,-1.06]。但是,对医疗总费用这一结局指标进行分析,发现试点后患者医疗总费用与试点前的差异无统计学意义。结论:按病种支付在一定程度上有利于降低肺结核患者负担,但还应进一步完善其支付模式,探寻适合我国肺结核防控的支付方式。
Objectives:To collect studies on case-based payment from tuberculosis patients published by national and international scholars within the last 20 years,and conduct evidence-based medical analyses in order to explore how changes in the payment model would affect the financial burden of pulmonary tuberculosis patients.Methods:Research articles were retrieved from databases including Chinese National Knowledge Infrastructure(CNKI)and PubMed with the keywords“pulmonary tuberculosis/tuberculosis”and“payment model”.According to the inclusion and exclusion criteria,the articles were screened using NoteExpress software,and Revman5.3 software was used to perform a meta-analysis on results from articles meeting the inclusion criteria.Results:Among 305 articles,only 10 articles met the inclusion criteria.Based on evidence-based medical analysis,the combined risk ratio(RR)for the outcome indicator of reimbursement rate was 1.20 with a 95%confidence interval of[1.11,1.30];on the other hand,analysis on the indicator of personal out-of-pocket costs rendered a standardized mean difference(SMD)of-5.56 with a 95%confidence interval of[-10.05,-1.06].However,the analysis of the outcome indicator of total medical costs revealed no statistically significant difference in the total medical costs of patients before and after the pilot implementation.Conclusions:Case-based payment model helped reduce the financial burden of pulmonary tuberculosis patients to a certain extent.However,the payment model for pulmonary tuberculosis treatment should be further improved.A payment model that is suitable for the prevention and control of pulmonary tuberculosis in China should be explored.
作者
张婧怡
高广颖
胡星宇
邓茜
张达
田佳帅
张礼亮
ZHANG Jing-yi;GAO Guang-ying;HU Xing-yu;DENG Qian;ZHANG Da;TIAN Jia-shuai;ZHANG Li-liang(School of Public Health,Capital Medical University,Beijing 100069,China)
出处
《中国卫生政策研究》
CSCD
北大核心
2022年第1期50-56,共7页
Chinese Journal of Health Policy
基金
国家自然科学基金项目(71874113)。
关键词
肺结核
医保支付模式
META分析
Tuberculosis
Medical insurance payment models
Meta analysis
