四个地市耐多药肺结核医疗服务包费用分析

目的 制定标准化耐多药肺结核医疗服务包，为推广耐多药肺结核免费医疗政策提供依据。方法 采用专家会议头脑风暴法建立耐多药肺结核医疗服务包，服务包包括七大类服务项目，分别为诊断、住院前检查、住院治疗、出院后随访检查、心理支持、并发症和不良反应处理、患者督导，并根据重庆市、呼和浩特市、开封市和连云港市的定点医疗机构、结核病防治机构和社区卫生服务机构的2010年各项医疗服务及药品实际价格，分析医疗服务包费用。 结果 耐多药肺结核患者全疗程医疗服务包治疗费用均值为32 617元，在各服务类别的费用中，最高的为药品费用，平均为13 722元，占平均总费用的42.07％(13 722/32 617)。在各机构的费用中，最高的为地市级定点医院费用，平均费用为26 527元，占平均总费用的81.33％(26 527/32 617)。按耐多药肺结核患者全疗程24个月，分别统计各月份费用，费用最高的是需要住院治疗的第1个月和第2个月，第1个月的平均费用为5879元，占总费用的18.02％（5879/32 617），第2个月的平均费用为2651元，占总费用的8.13％（2651/32 617）。 结论 耐多药肺结核医疗服务包主要用于规范医疗服务行为，限制医疗费用的支出，对于全国推广规范化耐多药肺结核治疗管理工作有参考作用。

Medical service package and expenditure analysis of multi-drug resistant tuberculosis

Objective To develop standardized medical service package of multi-drug resistant tuberculosis （MDR-TB） so as to provide evidence for the promotion of free health care policy for MDR-TB. Methods Experts meetings were organized to establish the MDR-TB medical services package. The MDR-TB medical services package includes seven categories： diagnosis, pre-admission examination, hospitalization, follow-up, psychological support, treatment of complications, adverse reaction and DOT. To analyze the expenses of medical services package based on the actual price of medical services in the four prefecture level designated hospitals. Results The average expenses of services package for the whole course of MDR-TB treatment is 32 617 yuan. Of all service categories, the highest incurs in drug expenses with an average of 13 722 yuan, accounting for 42.07%（13 722/32 617） of the average total cost. Of the agencies, the largest is spent in the prefecture level hospital with an average of 26 527 yuan, accounting for 81.33%（26 527/32 617） of the average total. In 24-month treatment of MDR-TB patients, the highest expenses is incurred in the first and second month of hospitalization. The expenses of the first and second month is 5879 yuan and 2651 yuan, accounting for 18.02%（5879/32 617）and 8.13%（2651/32 617） of the total respectively. Conclusion MDR-TB medical service package is mainly used to standardize medical service behaviors, limits medical expenses, and provides reference for the promotion of standardized MDR-TB treatment.