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门诊特殊慢病政策对高血压合并并发症患者住院服务利用的影响
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The Effect of Outpatient Medical Insurance on Hospitalization Utilization Among Patient with Hypertension Complications
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    摘要:

    目的:探讨门诊报销政策对高血压合并并发症患者住院服务利用及费用的影响,为门诊保障政策设计提供实证依据。方法:利用新疆某地区2011年~2014年城镇职工医疗保险报销数据,采用有对照的间断时间序列研究,分析享受门诊慢病政策与未享受门诊慢病政策的高血压并发症患者在研究期间因单纯性高血压、高血压并发心脏病、高血压并发肾病及高血压并发脑病入院的每季度总住院费用及总住院时长的水平及趋势变化。结果:2011年至2014年,享受政策与未享受政策组患者住院总费用分别降低了33.80%和13.23%,其中享受政策组患者因单纯性高血压而入院的住院费用的降幅高于未享受政策组47.48%,每季度住院总费用呈显著的下降趋势;享受政策组患者因单纯性高血压和高血压并发脑病而住院的患者总住院时长缩短了42.06%和35.02%,而未享受政策组因单纯性高血压住院患者住院时长显著升高。结论:门诊特殊慢病政策降低了高血压合并并发症患者以因单纯高血压为主的住院服务利用及费用,卫生决策者应充分考虑保障不同疾病状态下患者的门诊医疗费用。

    Abstract:

    Objective: To explore the effect of outpatient medical insurance on inpatient services of patients with hypertensive complications, then provide empirical evidence on designing outpatient policies. Methods: The data were from one area in XinJiang from 2011 to 2014 for urban employee basic medical insurance database, Intermittent time series model with control group was used to analyze the level and trend of hospitalization expenses and length by patients with Poor control of blood pressure, Hypertension complicated by heart disease, Hypertension complicated by kidney disease and Hypertension with encephalopathy during the study period. Results: From 2011 to 2014, the total hospitalization expenses of Policy beneficiaries and non-beneficiaries were reduced by 33.80% and 13.23%, respectively, as compared with the decrease in the non-beneficiaries group, the decline in hospitalization expenses was 47.48% higher among the patients with Poor control of blood pressure in beneficiaries group, which has a downward tendency in the Hospitalization expenses per quarter significantly. The total length of hospitalization among patients with Poor control of blood pressure and Hypertension with encephalopathy in beneficiaries group were reduced by 33.80% and 13.23%, respectively, but increased in non-beneficiaries group. Conclusion: Cause of outpatient medical insurance, the Hospital utilization and expenses due to simple hypertension among patients with hypertensive complications were decreased. Health policy makers should consider the protection of outpatient medical expenses of patients with different disease states

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李珂,李小菊,张梅,等.门诊特殊慢病政策对高血压合并并发症患者住院服务利用的影响[J].中国卫生经济,2017,(8):20-23.门诊特殊慢病政策对高血压合并并发症患者住院服务利用的影响[J]. CHINESE HEALTH ECONOMICS,2017,(8):20-23.

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