| 谢靳希,田野,洪妍,胡华杰,管晓东,史录文.医保总额预付改革对县级公立医院住院患者合理用药影响研究[J].中国药事,2019,33(1):85-89 |
| 医保总额预付改革对县级公立医院住院患者合理用药影响研究 |
| An Impact Study on Medical Insurance Reform of Total Advance Payment on Rational Drug Use of Inpatients in County-level Public Hospitals |
| 投稿时间：2018-06-30 |
| DOI：10.16153/j.1002-7777.2019.01.015 |
| 中文关键词: 总额预付 按项目付费 医保支付方式改革 合理用药 |
| 英文关键词: total advance payment payment-for-service medical insurance payment reform rational drug use |
| 基金项目: |
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| 中文摘要: |
| 目的：对比实施总额预付和按项目付费的县级公立医院住院患者的用药差异，探讨总额预付改革对住院患者合理用药的影响，为科学推进医保支付方式改革提供建议。方法：针对样本医院儿科和呼吸科主要诊断为社区获得性肺炎的医嘱用药信息，使用单因素分析法探究两种支付方式在住院指南推荐用药符合率、抗菌药使用率、抗菌药联合使用率以及激素使用率四项指标上的差异。结果：相比按服务项目付费，总额预付制下的指南推荐用药符合率更高，抗菌药使用和联用率均更低，激素使用率更低，但呼吸科的结果存在一定差异。结论：总额预付对促进合理用药有一定效果，但合理用药水平仍有待加强，建议实施多种促进合理用药的策略来提升合理用药水平。 |
| 英文摘要: |
| Objective:To compare the differences of inpatients' drug use between total advance payment with payment-for-service in county-level public hospitals, discuss the impact of total advance payment reform on inpatients' rational drug use so as to provide suggestions for scientifically promoting the reform of medical insurance payment methods. Methods:In terms of the drug use information of inpatients diagnosed by community-acquired pneumonia (CAP) from pediatric and respiratory departments of sample hospitals, univariate analysis was applied to analyze the differences between two payment methods in the four indicators recommended in hospitalization guide, such as medication compliance rate, antibiotics use rate, antibiotics combined use rate and hormone use rate. Results:Compared with the payment-for-service group, the total advance payment group had higher medication compliance rate, lower use rate and combined use rate of antibiotics, as well as lower hormone use rate. However, there were some differences in the respiratory departments. Conclusion:The total advance payment had certain effects on promoting rational drug use, but rational drug use still needed to be improved. It is suggested various strategies be implemented to enhance rational drug use. |
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