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目的:分析河南省县级医院新农合按病种付费支付方式改革对住院患者药品费用及药占比的作用效果。方法:采取目的抽样方法,选择河南省焦作沁阳市人民医院作为试验组,博爱县人民医院作为对照组,利用双差法的研究设计,分析在不同病种中支付方式改革对住院患者药品费用及药占比的影响。结果:按病种付费改革使阑尾炎和胎位异常分娩患者的住院药品费用明显下降,分别下降了334元(P=0.025)和330元(P<0.001),对小儿腹股沟疝患者的住院药品费用没有显著影响。改革使阑尾炎和胎位异常分娩患者的药占比显著降低,其中阑尾炎患者的下降了接近10个百分点(P=0.004),胎位异常分娩患者的下降了15个百分点(P<0.001),而小儿腹股沟疝患者的药占比提高了近2个百分点(P=0.013)。结论:按病种付费制度改革减弱了医务人员以药养医的激励,住院期间的药品使用更加合理。
OBJECTIVE: To analyze the effect of the reform of payment system of NRCMS in county-level hospitals in Henan province on the cost of drugs and the proportion of drugs in hospitalized patients. Methods: Taking the purpose of sampling method, select Qinyang City People’s Hospital of Jiaozuo, Henan Province as the experimental group and the People’s Hospital of Bo’ai County as the control group, using the double difference method to study the design and analysis of the payment method reform in different diseases on inpatients’ And the proportion of medicine. Results: The cost of hospital admissions for patients with appendicitis and abnormal fetal delivery decreased by 334 yuan (P = 0.025) and 330 yuan (P <0.001), respectively. The cost of hospitalization for children with inguinal hernia was significantly lower Significantly affected. The reform led to a significant decrease in the proportion of patients with appendicitis and abnormal fetal delivery, including a decrease of nearly 10 percentage points in patients with appendicitis (P = 0.004) and a 15-point decrease in patients with abnormal fetal delivery (P <0.001) Hernia patients accounted for the proportion of drugs increased by nearly 2 percentage points (P = 0.013). CONCLUSION: The reform of payment system according to the disease has weakened the motivation of medical staff to provide medicine and medicine, and the use of medicines during hospitalization is more reasonable.