糖尿病患者门诊就医流向与费用分析——基于某省新农合数据

孙美平; 刘艳; 朱微微; 简伟研

引用本文：孙美平, 刘艳, 朱微微, 简伟研.糖尿病患者门诊就医流向与费用分析——基于某省新农合数据[J].中国卫生政策研究,2017,10(11):52-58

糖尿病患者门诊就医流向与费用分析——基于某省新农合数据

投稿时间：2017-03-27 修订日期：2017-10-31 PDF全文浏览 HTML全文浏览

孙美平¹, 刘艳¹, 朱微微², 简伟研¹

1. 北京大学医学部公共卫生学院北京 100191;
2. 国家卫生计生委医院管理研究所北京 100191

摘要:目的：探究糖尿病患者门诊就医流向与费用特点，为分级诊疗等相关卫生政策的实施与推广提供理论根据。方法：选取东部某省13个区县，采用描述性统计，分析糖尿病患者在一、二、三级医疗机构的就诊分布和诊疗费用情况。结果：2009—2013年无并发症糖尿病患者在三级医疗机构的诊疗人次由1 895降低到661，其占比由3.05%降低到0.57%，有并发症患者在三级医疗机构的诊疗人次由179增加到524，且在2011—2013年间，其占比由3.27%增加到4.24%。两类患者门诊次均费用和次均个人负担差别较大，且级别越高，差别越大；在一、二、三级医疗机构中，有并发症患者的次均费用分别是无并发症患者的2.50倍、3.34倍、3.75倍，前者的次均个人负担费用分别是后者的2.62倍、3.66倍、3.96倍。结论：该省基层门诊服务利用取得一定成效，但也存在着患者就医选择的不合理，有并发症糖尿病的患者越来越多的流向三级医疗机构；相比于无并发症患者，有并发症患者面临更大的经济负担。未来应进一步加强基础医疗机构建设，提升其预防、诊疗和控制糖尿病及并发症的服务质量与能力，合理引导糖尿病患者到基层医疗卫生机构就医。

关键词:新农合糖尿病患者门诊就医流向医疗费用

基金项目:糖尿病分级诊疗政策研究项目

The analysis of seeking behavior and medical expenses for diabetic outpatients of New Rural Cooperative Medical Scheme in eastern areas of China

SUN Mei-ping¹, LIU Yan¹, ZHU Wei-wei², JIAN Wei-yan¹

1. School of Public Health, Department of Health Policy and Management, Peking University, Beijing 100191, China;
2. National Health and Family Planning Commission, National Institute of Hospital Administration, Beijing 100191, China

Abstract:Objective:To investigate the characteristics of seeking behavior and medical expense of outpatients in the New Rural Cooperative Scheme, and provide suggestions and theoretical basis for the implementation and promotion of hierarchical medical policy systems. Methods:In this study, 13 counties in the eastern part of China were selected. By using data about diabetes mellitus distribution and medical expense of outpatient service reimbursement database in Beijing New Rural Cooperative Medical Scheme from 2009 to 2013, the diabetes mellitus were divided into two groups:with complications and without complications; the number of visits and proportion of the first-class, secondary-and tertiary-level medical institutions and the average annual growth rate of the five-year were calculated and the total expense, the average cost, the individual burden and the annual growth rate of the two types of diabetes mellitus were statistically analyzed. Results:The visits in the tertiary medical institutions of diabetes mellitus without complications decreased from 1895 to 661 and the proportion decreased from 3.05% to 0.6% from 2009 to 2013, while the visits in the tertiary medical institutions of diabetes mellitus with complications increased year by year and the proportion increased from 3.27%~4.24% since 2010. Outpatient medical expenses varied widely between patients with and without complications and the higher the level, the greater the difference between the two. At the first-class, secondary-and tertiary-level institutions, the average expenses per time of diabetes mellitus with complications were 2.50, 3.34 and 3.75 times higher than the diabetes mellitus without complications and the average out-of-pocket expenses per time were 2.62, 3.66 and 3.96 times higher than the latter respectively. Conclusions:From 2009 to 2013, the utilization of primary outpatient service in the region achieved some success while there were still some problems including unreasonable outpatient distribution, and more diabetic patients with complications went to the tertiary-level institutions than those without complications. Compared with outpatients without complications, patients with complications face up to a larger direct-economic burden of disease. The construction and the ability to prevent and control diabetes mellitus of basic medical institutions should be further strengthened, and the distribution of patient needs to be reasonably led to enhance the service quality and ability of preventing, treating and controlling diabetes and complications, and to guide patients with diabetes to seek medical treatment in primary healthcare institutions.

Key words:The new rural cooperative medical Scheme Diabetes patients Outpatient service Seeking behavior Medical expense

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