The Influence Of National Medical Insurance Negotiated Anti-cancer Drugs On Hospitalization Expenses And Medical Insurance Payment

Objective:In 2018,the special negotiation on access to medical insurance for anti-cancer drugs is an important measure for the country to reduce the economic burden of medical treatment for cancer patients.Of this study is to through the analysis of hospitalization cost,cost structure,cost influencing factors and medical insurance payment of medical insurance patients in a 3a public hospital in Guangzhou before and after the implementation of the policy,evaluate the effect of national medical insurance Negotiated anti-cancer drugs on hospitalization expenses and medical insurance funds,and provide empirical reference and Suggestions for further reform.Methods:This study collected information and cost details of target inpatients in a 3a public hospital in Guangzhou from 2018 to 2019.Literature research method was used to summarize the relevant practices and views at home and abroad;Non-parametric test method,discontinuous time series model and structural variability model were used to analyze the change of hospitalization costs and the cost differences among key departments after the implementation of the policy.Multivariate linear regression model was used to analyze the influencing factors of medical expenses and their importance.Analyze the operation of hospital medical insurance fund in combination with specific indexes of medical insurance.Results:(1)After the implementation of the policy,the total medical expenses per time,the total drug costs per time,the average negotiated drug costs per time,and the non-negotiated drug costs per time for hospitalized patients decreased,the average material costs per time,the average treatment costs per time,the average surgical costs per time,etc.Other expenses have risen to varying degrees.(2)At the implementation point of anti-cancer drug policy in national medical insurance negotiation,only the cost of the negotiated drug has significant instantaneous change,which leads to the instantaneous decrease of the total drug cost,while the increase of the cost of materials and treatment weakens the decrease of the total hospitalization cost.If the status quo is maintained,the total average cost per time will show an upward trend.(3)After the implementation of the policy,the rate of change in the structure of hospitalization expenses was 23.55%.The total drug costs per time,the average negotiated drug costs per time,and the non-negotiated drug costs per time showed negative changes,and the rest of the costs showed positive changes.The top five rankings contributing to the structural changes are negotiated drug fees,material fees,non-negotiated drug fees,treatment fees and laboratory testing fees,with a cumulative contribution rate of 85.14%.(4)The total hospitalization expenses for patients in the pulmonary department and lymphoma department have dropped significantly,while the decrease in the gastrointestinal department is not obvious,and the total cost of the hematology department has increased.The sharp drop in the cost of non-negotiated drugs has had a greater impact on the Department of Pulmonology and Lymphoma.The increase in the non-negotiated drug costs and laboratory test fees have had a greater impact on the Department of Hematology.(5)The degree of structural change of the four departments is,hematology> pulmonary> lymphoid oncology> gastrointestinal oncology.The proportion of medicines in the four departments has decreased,and the proportion of materials has increased;the proportion of examination fees in the lymphoma department has decreased,and the proportion of the remaining three departments has increased;the proportion of laboratory tests in the lung department has decreased,and the proportion of the remaining three departments has increased.In particular,it contributes greatly to the structural changes of the hematology department.The proportion of surgical treatment expenses in the four departments has increased more or less.(6)The factors affecting the average hospitalization cost of the target patients before and after the implementation of the policy are basically the same.They are the length of hospitalization,whether they are hospitalized for the first time,whether or not they have surgery,and the proportion of medicines.The proportion of medicines has a weaker impact on medical expenses after the implementation of the policy.(7)After the implementation of the policy,the difficulty of hospital treatment has increased slightly,and the structure of medical insurance expenses has improved.The average hospital medical insurance balance has been reduced from-7919.01 yuan to-4117.76 yuan.Conclusions:After the implementation of the policy,the patient’s medical treatment behavior has changed;the policy has reduced the patient’s medical burden to a certain extent,but the overall cost and cost structure still need to be optimized;the cost and cost structure of different departments vary significantly;the average hospitalization cost of the target group is affected by many factors;The loss of hospital medical insurance has decreased,but it is still in a serious state of loss.In the future,we should leverage on the advantages of the medical insurance negotiation system to further reduce the burden of drugs for cancer patients;use the "Joint Reformation for Public Health Services,Medical Insurance,and Medical Production-Circulation" as a starting point to comprehensively carry out the fine management of hospital;improve the medical insurance payment policy for the national negotiated drugs;explore the establishment of a multi-level medical insurance system for cancer patients;Improve health awareness and healthy behavior ability of the whole people.