重庆市活动性肺结核患者直接医疗费用及其构成分析

目的 了解重庆市成功治疗的活动肺结核患者直接医疗费用及构成情况,为制定医保政策提供依据。 方法 从《结核病管理系统》中导出重庆市2019年新诊断登记活动性肺结核患者（排除利福平耐药患者）病案,与2019年1月—2020年5月重庆市46家市/县级结核病定点医疗机构的门诊与住院诊疗记录、收费和报销等诊疗信息和费用结算信息进行匹配后,纳入该时间段治愈和完成疗程患者11 745例,以描述性分析其直接医疗费用及构成情况。结果 直接医疗费用共8 385.66万元,自费总费用占60.69%,每例患者直接医疗费用M（P₂₅,P₇₅）为4 517.00（2 143.95, 8 905.22）元、自费费用为2 989.12（1 305.58,5 700.14）元、医保报销费用为988.70（42.00,2 721.01）元;药品总费用占比最高（40.56%）,城镇职工医保患者住院比例及各项费用较其他医保类型患者高（α'=0.008（0.05/6）,均P<0.008）。全门诊和住院+门诊两种治疗方式每例患者直接医疗费用M（P₂₅,P₇₅）分别为2 806.88（1 621.75,4 746.12）元、10 860.60（7 543.95,16 393.56）元,医保总报销比例分别为16.78%和39.64%,城乡居民医保患者每例医保报销费用中位数高于其他类型（α'=0.008（0.05/6）,均P<0.008）;住院+门诊治疗方式下城镇职工医保患者每例医保报销费用中位数高于其他医保类型（α'=0.008（0.05/6）,均P<0.008）。结论 重庆市活动性肺结核患者直接医疗费用较高,其中自费比例较高,医保报销比例和医疗救助比例低,药品占比较高（40.56%）,治疗方式以全门诊治疗为主。应积极开展实行单病种付费医保政策,提高医保患者门诊报销比例和限额,规范定点医疗机构结核病诊疗管理。

Direct medical costs and its composition of active pulmonary tuberculosis patients in Chongqing

Objective To investigate the direct medical expense and constitution of active pulmonary tuberculosis（PTB）patients successfully treated in Chongqing, to provide a basis for health care policy. Methods The newly diagnosed cases of active PTB patients (Rifampicin resistant patients excluded) in Chongqing in 2019 were derived from the Tuberculosis Management System, matching the information (including outpatient and inpatient treatment records, fees and reimbursements, and other diagnostic and treatment information and billing information) from 46 district/county-level TB medical institutions in Chongqing from January 2019 to May 2020. Finally, 11 745 patients who had been cured and completed the course of treatment in this period were included, and their direct medical expenses and constitution were analyzed. Results The total direct medical expenses was 83.856 6 million yuan, of which 60.69% was self-financed. For each patient, the direct medical expense M（P₂₅,P₇₅） was 4 517.00 (2 143.95, 8 905.22) Yuan, the out-of-pocket expense was 2 989.12 (1 305.58, 5 700.14) Yuan, and the medical insurance reimbursement expense was 988.70 (42.00, 2 721.01) Yuan. The proportion of total medical expenses of drugs were the highest (40.56%) , the hospitalization proportion and various expenses of urban employees with medical insurance were higher than those of other types of medical insurance （α'=0.008 (0.05/6), all P<0.008). The direct medical expenses M（P₂₅,P₇₅） of patients with total outpatient treatment and inpatient + outpatient treatment were 2 806.88 (1 621.75, 4 746.12) Yuan and 10 860.60 (7 543.95, 16 393.56) Yuan respectively, and the total reimbursement proportion of medical insurance was 16.78% and 39.64% respectively. The median reimbursement expenses of medical insurance of urban and rural residents under total outpatient treatment were higher than those of other types（α'=0.008 (0.05/6), all P<0.008); Under the mode of inpatient + outpatient treatment, the median medical insurance reimbursement expenses of urban employees were higher than those of other medical insurance types (α'=0.008 (0.05/6), all P<0.008). Conclusions The direct medical expenses of common active PTB patients in Chongqing are high, among which the proportion of out-of-pocket expenses is high , the proportion of Medical Insurance Reimbursement and medical assistance is low, the proportion of drugs is high (40.56%) . All out-patient treatment is the main treatment. We should actively carry out the policy of single disease payment, increase the proportion and quota of reimbursement, and standardize the management of TB diagnosis and treatment in designated medical institutions.