典型国家DRG体系下新技术支付政策分析及启示

在我国深入推进按疾病诊断相关分组（DRG）付费改革的背景下,设计DRG体系下适宜的新技术支付政策以及纳入DRG体系,是避免改革对技术创新产生负面影响的重要手段,也是DRG付费改革设计时需考虑的重要因素。文章在深入探讨技术创新与DRG支付体系关系的基础上,选取美国和德国作为典型国家,比较分析两国新技术支付政策的设计亮点,以及纳入DRG体系的流程,结合我国新技术支付的现状,提出新技术选择、额外支付范围、短期支付和纳入DRG支付体系等方面的政策建议。     

Economic Impacts of the Generic Drug User Fee Act Fee Structure

Background

A Food and Drug Administration (FDA) Generic Drug User system, Generic Drug User Fee Amendment of 2012 (GDUFA), started October 1, 2012, and has been in place for over 3 years. There is controversy about the GDUFA fee structure but no analysis of GDUFA data that we could find.

新农合73万住院病例高额费用的影响因素分析

[目的]研究新型农村合作医疗（NCMS）住院病例高额费用的影响因素。[方法]收集福建省2007年新农合73万个住院病例数据库（含27项指标）,用logistic回归分析产生高额住院费（定义为万元以上）的影响因素,分析有关因素的交互作用与联合作用。[结果]导致高额住院费用的因素依次是：＂不可报销费用＂高（OR=41.1）;＂药费＂高（OR=10.2）;＂检查费＂高（OR=4.5）;＂住院久＂（OR=3.6）;＂出县住院＂（OR=2.6）。交互作用均有显著性。[结论]控制范围外的不可报销药品与检查费用,加强县内医疗机构建设,力争实现＂小病不出乡,大病不出县＂,是控制高额住院费用的重点措施。     

缓解居民“因病致贫”:“总额预付+按服务单元付费”组合支付方式预期效果之一

为了科学论证"总额预算+按服务单元付费"组合支付方式对于消除百姓高额医疗费用风险,缓解因病致贫的效果,运用因病致贫发生率及严重程度的计算方法,利用居民大规模家庭入户调查数据进行论证。结果显示按项目付费方式下因病致贫的发生率为2.05%,严重程度为15.70%,而组合支付方式可使其分别下降54.43%和89.68%,且效果远大于现行医疗保障的作用(21.52%和31.47%)。提示通过良好的费用共担机制,支付方式改变可大大减轻百姓医疗经济负担,缓解因病致贫,最终实现医改的"让百姓得到实惠"的目标。     

医学生教育成本核算的探讨

高等教育公平性在客观上要求成本核算,其核算机制的建立是完善教育收费制度的关键,也是成本控锖寸的基础。医学生教育与其它专业相比具有学制长、教学实践投入高且实践性强等特点,因此医学生教育成本明显高于其他专业的学生。实施高等教育成本核算选择会计法有其客观性,但需要改革现行高校会计制度。     

老年髋部骨折手术与非手术治疗费用与并发症比较

目的探讨手术与非手术治疗老年髋部骨折住院期间并发症及治疗费用状况,为选择治疗方式提供科学依据。方法:采用回顾性研究,选择病例标准:①年龄:60岁以上。②骨折类型:粗隆间与股骨颈基底部骨折;③非手术治疗:卧床,牵引,石膏固定,住院时间不少于6周;④手术方式:内固定术(Gamma钉、DHS、DCS、角度钢板,空心加压螺钉)。入选病例按治疗方式分两组,非手术组为A组52例,手术组为B组68例;比较两组间年龄、住院时间、住院医疗费用、并发症。结果:两组间在年龄[A组(80±9.5)岁,B组(78±8.6)岁,t=1.48,P>0.05]、住院总费用[A组(11.2±3.6)千元,B组(13.5±4.3)千元,t=1.79,P>0.05],差异上无显著性意义;而在并发症(A组69.8%,B组28.7%,χ2=22.08,P<0.001)、住院时间[A组(55±7.2)天,B组(26±5.7)天,t=24.35,P<0.001],有显著差异。结论:选择老年髋部骨折的治疗手段,要考虑多方面因素。合理选择不但能促进骨折愈合,而且也是减少医疗费用,节约医疗资源的重要一环。     

Impact of health maintenance organizations and fee‐for‐service on health care utilization among people with systemic lupus erythematosus

Objective

To compare health care utilization in people with systemic lupus erythematosus (SLE) in health maintenance organizations (HMOs) and fee‐for‐service (FFS).

Methods

A structured survey was administered to a cohort of 982 people with SLE who were assembled between 2002 and early 2005. A total of 2,656 person‐years of observation were completed by the end of 2005. In each year, respondents reported their health care utilization and whether they had HMO or FFS coverage. We compared health care utilization of those in HMOs and FFS, with and without adjustment for socioeconomic, demographic, and health characteristics using repeated‐measures regression techniques.

Results

Compared with people with SLE who were in FFS, those in HMOs were younger (3.3 years), received a diagnosis at an earlier age (3.6 years), had slightly less disease activity (0.4 on a 10‐point scale), were more likely to be nonwhite (8.8%), were less likely to be below the poverty line (7.8%), and were less likely to have public insurance (29.7%). The 2 groups did not differ in other characteristics. On an unadjusted basis, subjects with SLE in HMOs had significantly fewer physician visits (3.1; 95% confidence interval [95% CI] 1.7, 4.5) and were less likely to report one or more outpatient surgical visits (6.3%; 95% CI 2.5, 10.0), and hospital admissions (5.5%; 95% CI 1.7, 9.3) than those in FFS. Adjustment reduced the differences in physician visits (2.3; 95% CI 1.1, 3.5), outpatient surgical rates (4.4%; 95% CI 0.6, 8.1), and hospital admission rates (4.0%, 95% CI 0.4, 7.7).

Conclusion

Subjects with SLE in HMOs utilized substantially less ambulatory care and were less likely to have outpatient surgery and hospital admissions than those in FFS; the effects were not completely explained by socioeconomic, demographic, and health characteristics.

     

2016年美国FDA批准的新药分析

目的：对2016年美国FDA批准的新药进行分析,供医药界和相关管理部门参考。方法：通过FDA官网的药物创新专栏与Drugs@FDA数据库查阅、收集FDA批准新药的信息,进行统计分析。结果与结论：2016年,FDA共批准22个新药,比2015年大幅减少,也低于1997-2016年的年均新药数量（28个/年）,其中新药申请15个,生物制品许可申请7个。批准新药中获得优先审查、快速通道、突破性治疗和加速审批资格的分别为15个、8个、7个和6个,批准孤儿药9个。批准新药的治疗领域以抗感染药、抗肿瘤药和神经系统用药为主,剂型以注射剂、片剂为主。