Study On The Implementation Status Of Medication Guarantee Policy In Diabetes Outpatient Department

BackgroundDiabetes mellitus has become one of the major public health problems in China,placing a heavy burden on individuals,families and society.In order to reduce the medical expenses of patients with diabetes,promote the utilization of medical services for patients,and ensure the accessibility of medicines,China introduced the medication guarantee policy for diabetes outpatient in October 2019.The evaluation of the implementation status and effect of the policy will be conducive to promoting the implementation of the policy and further improving the existing policy.ObjectivesThis study aims to evaluate the implementation of the policy of diabetes outpatient medical guarantee in Shandong province,to analyze the policy effect regarding reducing medical expenses,promoting medical service utilization,improving accessibility of antidiabetic,to explore factors associate with policy implementation and provide evidences for improving the current policy.MethodsThis study employed both quantitative and qualitative study methods.Three cities located in the east,middle and west of Shandong province were selected as our study settings.Quantitative data were obtained from the medical insurance databases of the three cities.We collected the following information from the database:basic characteristics of patients,medical service utilization,medical expenses and medical insurance expenses of diabetic patients treated in outpatient during January 2020 and June 2021.In depth interviews were conducted with staff of medical insurance bureau and endocrinology doctors.A focus group interview was conduct with 4-6 diabetic patients who were covered by the studied policy.Excel and SPSS software were used for data collating and analysis.The influence of medication guarantee policy on medical service utilization,medical expense expenditure and promotion of primary care for diabetes patients was analyzed through reimbursement times,average cost per time,distribution of medical treatment and cost structure.Nvivo 11 software and subject frame method were used to encode and analyze qualitative data.ResultsBefore the introduction of the drug guarantee policy for diabetic outpatient,the outpatient guarantee methods for diabetic patients in the three sample cities mainly included outpatient chronic diseases guarantee and general outpatient overall reimbursement.Among them,City A did not set up general outpatient coordination,but included all diabetic patients in the range of gate slow guarantee,patients treated with insulin in the range of specific gate slow guarantee,and patients not treated with insulin in the range of general gate slow guarantee.Both City B and City C included diabetic patients with high costs and complications into the scope of gate delay insurance,and diabetic patients with drug treatment and no complications were reimbursed through general outpatient service.After the implementation of the medication guarantee policy for diabetic outpatient,the outpatient guarantee mode of diabetic patients in various cities has been adjusted and changed.Among them,City A continues to maintain its original policy,including diabetes medication patients into the general outpatient chronic disease coverage.City B and City C added new security in addition to the original door slow security and general outpatient coordinated security.However,the difference between the two cities is that the diabetic patients in City C can only get the cost compensation from one of the two types of outpatient medication insurance for diabetes and chronic disease insurance for general outpatient service.After the implementation of the medication guarantee policy for diabetic outpatient,the average outpatient cost of diabetic patients in the three sample cities showed a downward trend in the short term and gradually remained stable,and the average drug cost per time in each city was 83.59 Yuan,24.19 Yuan and 38.44 Yuan respectively,which was far lower than the data before the implementation of medication guarantee policy in diabetes outpatient clinic in previous studies,and the economic burden of patients was reduced.The outpatient visits of patients with diabetes in the three sample cities continue to increase and basically remain stable after 2021,and patient service utilization increases steadily.The average annual medical visits of most diabetes patients were less than 12 times,and those with average annual medical visits of less than or equal to 4 times accounted for 73%-84%,it may be related to the strict implementation of long-term prescription system for diabetic outpatient medication.In the three sample cities,the majority of diabetes patients seek medical treatment in first-level and below medical institutions.In City A,more than 75%of diabetes patients seek medical treatment in primary medical institutions,and in city B and city C,more than 99%of diabetes patients seek medical treatment in primary medical institutions.In the third sample cities,the type of diabetes medication in primary medical institutions is similar to that in secondary and tertiary medical institutions,and there are many types of medicines in primary medical institutions,which can basically meet the drug needs of patients and improve the accessibility of medicines.Conclusions and RecommendationsThe implementation of medication guarantee policy for diabetic outpatient has played an important role in reducing medical expenses for diabetic patients,promoting the utilization of medical services for patients,and ensuring the accessibility of drugs.However,there are still some problems in the process of system design and implementation:Medical security efficiency still needs to be improved,there are moral risks in medical service utilization,primary medical service capacity needs to be improved,drug supply and security mechanism needs to be improved,and the scope of payment is narrow,which limits the use of drugs for patients.Insufficient policy publicity and low cognition of patients;The basic medical insurance information system is not perfect,and the policy implementation is difficult.In view of the above problems,it is suggested to continue to improve the guarantee system of drug use in urban and rural diabetes clinics,and improve the capacity of community-level medical management services.Solve the contradiction between drug supply and demand,improve the mechanism of drug supply and guarantee;Strengthen policy publicity to promote the health management of diabetes patients;We will improve supporting measures and improve the efficiency of policy support.