丙型肝炎创新药医保准入支付政策对医药费用的影响研究

目的:分析天津和成都两地丙肝创新药医保准入支付政策对人均医药费用产生的影响,探究两地政策效果的差异及原因。方法:收集天津市2014年5月—2018年10月某定点医院的全部丙肝患者病历记录,以及成都市2016年1月—2019年6月医保数据。采用中断时间序列对政策实施前后人均医药费用的变化进行评估。结果:创新药准入支付政策实施后,天津人均医药总费用水平瞬时下降了7 753.43元,其中人均药费下降了5 718.34元,人均其他诊疗费用下降了2 035.09元(P0.01)。成都人均医药总费用水平瞬时上升了6 680.78元(P0.01),其中人均药费上升了6 917.20元(P0.01),人均其他诊疗费用长期趋势每月下降318.88元(P0.01)。结论:创新药医保政策的实施效果受到多个因素的影响,医保准入谈判极大降低了创新药费用,按人头付费政策的实施降低了其他诊疗费用。建议:应积极推进创新药国家准入谈判;在入围创新药支付标准全国统一的情况下,地方医保部门应积极推进实施门诊慢性病患者医药费用按人头支付或基于价值/疗效支付,进一步降低其他诊疗费用;因地制宜制定并落实创新药配套政策。

Study on the influence of negotiation and payment policy for the innovative drugs of hepatitis C and access to medical insurance on medical expenses

Objective: To analyze the impact of negotiation and payment Policy for Innovative Drugs of Hepatitis C and medical insurance access on the total medical expenses per capita in Tianjin and Chengdu, to explore the differences and reasons for the policy effects among the two places, and to provide evidence for the payment method of other types of innovative drugs after national price negotiation and reformulation. Methods: The medical records of all hepatitis C patients from a designated hospital in Tianjin from May 2014 to October 2018 and medical insurance data from January 2016 to June 2019 in Chengdu were collected. The interruption time series was used to measure the changes in total medical expenses per capita after the implementation of the Innovative Drug Policies in Tianjin and Chengdu. Results: In Tianjin, the total expenses per capita dropped by 7 753.43RMB, Drug costs per capita dropped by 5718.34RMB and other expenses per capita dropped by 2035.09RMB (p<0.01) immediately after the implementation of the Tianjin Innovative Drugs Policy. On the contrary, total expenses per capita increased instantaneously by 6 680.78RMB (p<0.01), Drug costs per capita increased by 6917.20RMB (p<0.01) and other expenses per capita dropped by 318.88RMB per month (p<0.01) after the policy in Chengdu. Conclusions: The implementation of medical insurance policies for innovative drugs is affected by many factors, and the negotiations conducted by medical insurance agencies are one of the factors driving the decline in medical costs. The implementation of the capitation policy has significantly reduced the examinations and diagnosis costs. It is hence suggested to carry out national negotiations for innovative drugs, to promote the implementation of capitation-based or value-based or efficacy-based payment reforms for chronic disease outpatients under the condition that the amount to be paid for the innovative drugs should be unified across the country, and to formulate the supporting policies that properly ensure the effective implementation of the innovative drugs policies.