宁夏药品招标采购对参保和自费病人住院费用的影响

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1、宁夏药品招标采购对参保和自费病人住院费用的影响作者：李吴萍，宋琦如，戴秀英，孙维红，张毓洪【摘要】目的比较医疗机构药品招标采购制度执行后对参保住院病人医疗费用的影响，寻找决定住院总费用上涨的主要收费项目。方法比较2006—2007年度，由公办的24所二级综合医院前10位病种的病案资料中，参保与自费住院病人药品招标前后医疗费用的变化情况以及各项费用对住院总费用的影响。结果参保病人住院平均天数（12d）高于自费病人（8d）,Z=33.271,P＜0.001；参保病人住院医疗费用是自费病人的2.26倍（Z=59.607，P＜0.001）。药品统

2、招后药品费用呈负增长，参保病人组药品费用平均减少47.5元，递减3.33%，自费病人组药品费用平均减少37.0元，递减6.69%。多因素分析：药品费用、其它费用的减少是住院医疗费用下降的主要因素，而床位费、护理费、实验室检查费、手术费是造成住院医疗费用增加的主要因素。结论完善医疗保险制度的监管机制，以有效降低医疗费用；药品招标后需注意床位费、护理费、实验室检查费、手术费用对患者住院费用上涨的影响。【关键词】药品招标；医疗保险；住院病人；医疗费用TheImpactofDrugePurchasebyPublicBiddingonMedical

3、11ExpensesofInsuranceandSelfpaidInpatientsinNingxia　　SchoolofPublicHealth,NingxiaMed.Univ.,Yinchuan750004　　Abstract:ObjectiveTocomparetheimpactonmedicalexpensesofthemedicalinsuranceinpatientsbeforeandafterdrugepurchasedbypublicbiddinginNingxia,tofindthemainchargeitemsw

4、hichcausetheincreaseofthetotalcostofinpatientsandtoprovideinformationforfurtherdeepeningthereformoftheMedicalSecuritySystem.MethodsInformationwascollectedfromcasesofstatisticaldataof10anteriordiseasesin24publiclevelIIHospitalsfrom2006to2007andcomparisonofthechangesofinp

5、atientmedicalexpensesbeforeandafterdrugpurchasedbypublicbiddingandtheimpactofthemainchargeitemsonthetotalcostofhospitalwereanalyzed.ResultsAfterthedrugepurchasedbypublicbidding,theaveragehospitalizeddaysininsuranceinpatientswas12daysanditwassignificantlyhigherthanthatins

6、elfpaidinPatients(8days,Z=33.271,P＜0.001).ExpensesofinsuranceinPatientswas2.26timesasexpensesofSelfpaidinPatientsin10anteriordiseases(Z=59.607,P＜0.001）.Afterpublicbidding,11drugexpensesininsuranceinpatientswereaveragereduced47.5yuan（3.33%）andtheywerereduced48yuan（

7、6.69%）inselfpaidinpatients.Multifactoranalysisshowed:Majorfactorsofreducinghospitalcostsweredrugcostsreduction,othercostreductionandincreaseofbedcharges,nursingcost,laboratorycost,surgicalcostcausedtherisingofhospitalcosts.ConclusionInordertoeffectivelycontroltherising

8、ofhospitalcosts,itisimportanttoimprovethemedicalsecuritysystemmonitoringmeasures.Increasingofbed