| The Sichuan Municipal Public Hospitals have fully implemented the drug add-on policy since December 20,2016.Due to the difference of socio-economic development,medical resource distribution,hospital scale and residents' health level,the relevant policies and compensation mechanisms,the impact of the cancellation of drug add-on policy is also different.In addition,different diseases differ greatly in clinical diagnosis,treatment and medical resource consumption.Therefore,it is necessary to evaluate the impact of drug add-on policy cancellation on Municipal Public Hospitals in Sichuan Province,as well as the impact on reimbursement for medical insurance and burden of disease for patients with different diseases.This study extracted the disease information and hospitalization expenses data of patients who were diagnosed as "type 2 diabetes" and "cholecystolithiasis with chronic cholecystitis" from May 2015 to August 2018 through a hospital information system in a comprehensive tertiary hospital in Chengdu.In order to evaluate the impact of policy implementation on medical insurance reimbursement,medical expense structure and patient's disease burden,time series analysis method was used to analyzed and compared the actual reimbursement ratio and amount,the average hospitalization day,the total hospitalization expenses,the sub-average expenses,the proportion of each expense,the patient's self-pay ratio and cost before and after the drug add-on policy.Data cleaning,statistical analysis,and mapping were performed using Microsoft Excle,IBM SPSS Statistic 25.0,and Origin 2018 software,respectively.The results showed that the drug fees,drug proportion and total hospitalization expenses of patients decreased significantly,and the disease burden of patients were alleviated to a certain extent after cancelling drug add-on policy.The structure changes of hospitalization expenses of patients in internal and external medicine are different.The effect of the reform on reducing total cost of hospitalization was more significant in patients with type 2 diabetes mellitus,of which the proportion of drug fees,examination fees,laboratory fees and treatment fees exceeded 90% of total cost.The proportion of material fees and drug fees in patients with gallbladder stones and chronic cholecystitis was nearly 70%,and the effect of reform on reducing drug costs was more significant than that of type 2 diabetes mellitus.Through adjustment of medical service prices,the cost of testing and treatment in type 2 diabetes mellitus patients increased significantly,while the cost of operation and anesthesia in patients with cholecystolithiasis and chronic cholecystitis increased significantly.The reimbursement ratio of medical insurance in patients with cholecystolithiasis and chronic cholecystitis were much lower than those with type 2 diabetes mellitus and the reimbursement of medical insurance and selfpayment of patients were not affected by the reform.After the reform,the hospitalization expenses of patients were reduced,the service fees and treatment fees which reflected the labor value of the medical staff were improved,and the disease burden of the patients was alleviated,and the phenomenon of “expensive medical treatment” was somewhat relief.However,the adjustment of the fee structure has also led to unreasonable increases in laboratory tests and medical consumables.Therefore,it is recommended to refine the compensation policy according to the economic characteristics of each region,the size of the hospital structure and the specific conditions of different departments and avoid the “one size fits all” implementation price adjustment plan to ensure the operation of public hospitals.It is necessary to continue to optimize the medical expense structure and reasonably control the laboratory inspection and consumables costs,and to ensure that the medical burden of patients is not increased,as well as improving the medical service price system and establishing a dynamic adjustment mechanism. |
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