| Objective Through researching the medical insurance special drugs'(Herceptin, Gleevec, Tasgina) usage in Jiangsu Province, we described the usage and management status of medical insurance special drugs, analyzed the influence on t medical insurance fund and individual burdens, explored to improve the medical insurance system and ensured the sustainability of special drugs' policy, to provide a reference for other non-directory drugs' access.Method Through the Internet, the government websites and other platforms to collect treatment, policy documents or management that related to breast cancer, chronic myelogenous leukemia and gastrointestinal stromal tumor, focus on collecting medical insurance management policy about Herceptin, Gleevec and Tasgina, and synthetically analyze medical management policies and systems of analysis of medical insurance special drugs in Jiangsu Province.Through the cities of Jiangsu province'medical insurance fund management center to collect the data about medical insurance special drugs, in 13 provincial cities (represented by A City-M City)7 city level data was relatively intact, as sample data for analysis. Through interview questionnaire, we surveyed 188 chronic myelogenous leukemia patients, analyzing patients with chronic myelogenous leukemia. We interviewed the city of A, H and I' medical insurance fund management center staff, special drugs' responsibility physician, the patients who using special drugs, drugstores'responsible person, there were 12 people of medical insurance fund management center staff,9 people of responsibility physician,25 patients who using special drugs, one person in charge of designated pharmacies.Using SPSS19.0 to analyze the sample cities'overall cost of using special drugs; the number of special drugs, expenses; constitute of medical expenses; medical insurance reimbursement ratio; individual burden, the release of patients' need and the medical insurance fund balances.Using Epidata3.0 to establish a database to entry patients with drug usage'survey data, and using SPSS19.0 to descriptive analysis patients who using special drugs, including the patients' information (age, gender, disease); medical expenses economic burden and special drugs'usage and so on.Using the functional assessment of cancer therapy generic scale Chinese version (FACT-BRM) evaluated the quality of life CML patients, using SPSS 19.0 multivariate regression to analyze the factors affecting the quality of life, from the perspective of the general demographic characteristics.Results1. The economic burden of patients greatly reduced after Jiangsu Province' special drugs policies' implementation; attn supporting measures ensured the system safely and stability operation, but long-term shortage of health care agencies faced new challenges.2. In 2013, there were 642 insured urban workers who using special drugs in 7 cities, the total cost medical expenses was 100184000 yuan, special drugs costs 51062000 yuan, special drugs costs accounted for 50.97%; the average medical costs was 156000 yuan, the average special drugs costs was 8000 yuan; the costs paid by urban workers medical insurance fund was 70944000 yuan, the urban workers medical insurance fund payment rate was 70.81%. the costs paid by urban workers medical insurance fund accounted for 0.76% of fund expenditure, accounting for 6.62% of the fund balances; breast cancer patients'personal burden ratio was 29.77%, chronic myeloid leukemia patients' personal burden ratio was 28.67%, gastrointestinal stromal tumors patients' personal burden ratio was 26.16%.In 2013, there were 43 insured urban residents who using special drugs in 7 city, the total cost medical expenses were 5457000 yuan, special drugs costs 3279000 yuan, special drugs costs accounted for 60.08%; the average medical costs was 127000 yuan, the average special drugs costs was 7600 yuan; the costs paid by urban residents medical insurance fund was 3538000 yuan, the costs paid by urban residents medical insurance fund payment rate was 64.84%. The costs paid by urban residents medical insurance fund accounted for 0.31% of fund expenditure, accounting for 5.23% of the fund balances;breast cancer patients' personal burden ratio was 33.99%,chronic myeloid leukemia patients'personal burden ratio was 34.94%, gastrointestinal stromal tumors patients' personal burden ratio was 38.84%.3. In 2013, the number of patients who using Herceptin increased 521 than in 2012, increased by 70.79%; the number of patients who using Gleevec increased 311 than in 2012, increased by 41.08%. In the first half of 2014 in Jiangsu Province, the person-time of insured patients was 2891, increased 551 person-time than in 2013, increased 216 person-time in which the city level, district level increased 335 person-time.In the first half of 2014 in Jiangsu Province medical insurance fee was 1.5 billion yuan, increased by 0.3 billion yuan more than 2013 full-year' 1.2 billion yuan.4. The chronic myelogenous leukemia patients in the 20-39 years old accounted for 27.7%,40-59 years old accounted for 50.0%; 60.0% were insured urban workers,18.2% were insured urban residents,16.0% were the new rural cooperative medical insurance patients., annual household income less than 15,000 yuan accounted for 4.6%, more than 105,000 yuan accounted for 2.3%; annual household expenditure less than 15,000 yuan accounted for 7.5%, more than 105,000 yuan accounted for 5.6%; annual medical expenses less than 1.5 million accounted for 7.9%, more than 10.5 million accounted for 11.5%; individual out-of pocket medical expenses less than 1.5 million accounted for 13.1%, more than 10.5 million accounted for 4.1%; The proportion of individual out-of pocket medical expenses accounted for annual household expenditure more than 41% was 58.3%.3.7% of the patients started with Gleevec or Tasgina in 2012, 56.7% of patients started in 2013,39.6% of patients started in 2014. After treatment 2.6% of patients considered cured,62.1% believed that the condition under control,34.6% thought better; 100% of the patients intended to continue medication; 91.3% of patients gained charitable assistance. Chronic myelogenous leukemia patients thought high costs accounted for 28.9%, financial difficulties accounted for 47.2%, dispensary difficult accounted for 11.9%.5.Multiple regression analysis showed that the quality of life in patients with chronic myeloid leukemia compared was poor, the quality of life was higher in patients who were insured urban workers; the higher education level, economic status, the higher the quality of life for patients; the greater the age, the lower the quality of life of patients. The degree of influence on the total score in descending order was educational level, economic status, insurance type, age.ConclusionThrough the implementation of special drugs policies, the economic burden of breast cancer patients, chronic myeloid leukemia patients and gastrointestinal stromal tumors patients was significantly reduced in Jiangsu Province, implementation of policies got a good social response, attn supporting measures ensured the system safely and stability operation, but in the implementation process of special drugs policies also exposed the lack, mainly included the definition standard of coverage, responsibility physician' supervision and evaluation, special drug review assessment mere formality; people expect was increasingly higher, the release of demand for medical services was bigger, health insurance fund had pressure. |
PDF Full Text Request