北京医耗联动综合改革对肿瘤专科医院的影响——基于北京某肿瘤医院医保数据的实证分析

目的:分析北京市医耗联动综合改革对某肿瘤专科医院住院医保人群收治产生的政策影响,为改革的深入开展和完善提供参考。方法:检索医保系统与病案首页数据,时间段为2019年3月~9月,其中3月1日—6月14日为改革前。以半月为时间序列,运用间断时间序列回归分析住院人群的费用负担以及费用结构变化,并运用最小二乘法对政策影响进行多因素回归探讨。结果:共34015例住院患者,其中改革后18185例、占53.46%;患者次均费用存在下降趋势;改革未实际影响患者个人负担金额,且实际报销比例显著提升了2.198%;药占比的微幅上涨趋势得到控制,材料占比显著下降了1.940%,手术费占比和病理费占比分别提升了1.621%和0.608%。结论:在不影响个人负担的前提下,改革减弱了医院对物料(药品、耗材)收入的依赖,医务人员的技术劳动(手术、病理)得到了一定程度的体现。但实际报销比例有所提升,需要重点关注基金运行的平稳性和可持续性,同时还要进一步提升医保公平。

Impacts of medical and consumables linkage reform on tumor hospital: An empirical analysis based on medical insurance data from a tumor hospital in Beijing

Objective: To analyze the impacts of the medical and consumables linkage reform on a tumor hospital in Beijing, and provide reference for further development and adjustment of the reform. Methods: Data of this research were retrieved from the medical insurance system and medical record system. The research was carried out during the period from March to September 2019, and the date of June 14^th was selected as the reform point. Taking half of a month as the time series, interrupted time series segmented regression model was used to analyze the instant change in cost burden and change of trend in cost structure for the inpatients, and the least squares method was applied to explore the multi-factor regression of policy impact. Results: A total of 34,015 inpatients, including 18,185 cases after the reform were enrolled, which accounted for 53.46%. The average cost of patients had a downward trend. The reform did not actually affect the patient''s personal burden, and the actual reimbursement rate experienced a significant increase of 2.198%. The trend of the slight increase in the proportion of medicines was controlled while the proportion of materials dropped significantly by 1.940%, and the proportion of surgical expenses and pathological expenses slightly increased by 1.621% and 0.608%, respectively. Conclusions: Under the premise of not affecting the patient''s personal burden, the reform has weakened the hospital''s dependence on the income of materials (drugs, consumables), but the medical personnel''s technical labor (surgery, pathology) has been reflected to a certain extent. However, the actual reimbursement rate has increased. Therefore, it is necessary to focus on the stability and sustainability of the fund operation, and to further improve the fairness of medical insurance.