Study Of The Impact Of Bringing High-cost Pharmaceuticals Into Medical Insurance On Drug Utilization And Medical Costs

[Purpose] To compare and analyze the changes in drug utilization and inpatient medical expenses of schizophrenia patients before and after the inclusion of antipsychotics in medical insurance,in order to explore the main factors influencing the application of new selected antipsychotics in medical insurance and propose the reasonable suggestion for improving the relevant supporting policies and measures after the inclusion of high-cost pharmaceuticals in medical insurance.[Methods] Institutional survey was conducted in Wuhan Medical Insurance Management Center,in order to collect detailed data of medical insurance compensation and expenses for schizophrenia patients insured by URBMI and UEBMI in Wuhan city from 2016 to 2018.Qualitative data were collected through field interviews with relevant people in charge in Wuhan Medical Insurance Management Center and Mental Health Center.Excel was used for data screening,SPSS25.0 Software was used for data statistical analysis,the date(September 2017)of the implementation of new version of medicine catalogue for basic medical insurance in Hubei Province was set as the intervention point.Descriptive analysis and Univariate analysis were conducted to evaluate the implementation effects after the inclusion of antipsychotics in medical insurance.Generalized Linear Mixed Effect Model(GLMM)and Linear Mixed Effect Model(LMM)were used for multivariate analysis,based on the theory of Supply and Demand of Health Services and Behavioral Economics,the influence mechanism of the inclusion of antipsychotics into medical insurance on drug application and patients’ out-of-pocket medical expenses was explored.[Results] The price of new selected antipsychotics dropped significantly after being included in medical insurance.Among the new selected antipsychotics,the prices of quetiapine sustained release tablets,piperopirone and blonanserin decreased by 20.4%,19.5% and 12.3%,respectively.The utilization rate of new selected antipsychotics increased from 0.6% to 1.4% after being included in the medical insurance,and the proportion of DDDs and sales amount increased simultaneously,but there was still a large gap compared with some commonly used antipsychotics.The defined daily cost of new selected antipsychotics(23.6yuan)was much higher than the average level of all antipsychotics(1.0 yuan).The average inpatient medical expenses of patients using new selected antipsychotics dropped from 14,602.3 yuan to 1,2013.2 yuan,which was still higher than that of patients using antipsychotics in original medicine catalogue(9,850.9 yuan).The cost of new selected antipsychotics dropped from 4.8% of the total hospitalization expenses to 3.6% after being included in the medical insurance,The proportion of drug expenses of patients using new selected antipsychotics decreased simultaneously(from 10.5% to 9.7%),which was still higher than that of patients using antipsychotics in original medicine catalogue(6.8%).The proportion of non-reimbursable expenses for patients using new selected antipsychotics decreased significantly,from 9.0% before being included in the medical insurance to 3.2%.The actual compensation level was improved,and the out-of-pocket medical expenses of patients using new selected antipsychotics decreased from 4,280.9 yuan to 3,390.4 yuan,which was still higher than that of patients using antipsychotics in original medicine catalogue(2848.1 yuan).The results of multivariate analysis showed that under the control of factors related to patients’ basic characteristics and service utilization characteristics,the utilization rate of new selected antipsychotics was higher than that before being included in the medical insurance(P=0.016),and the out-of-pocket medical expenses of patients using new selected antipsychotics was lower than that before being included in the medical insurance(P=0.021).In addition,the patient’s medication pattern(P=0.030),institution category(P=0.003)and economic type(P=0.048)were also the key factors that affect whether patients use new selected antipsychotics.The patient’s medical insurance type(P<0.001),length of stay(P < 0.001),medication pattern(P=0.022),use of auxiliary psychotropic drugs(P=0.004)and institution economic type(P=0.019)were the influencing factors of patient’s out-of-pocket medical expenses.[Conclusions] After being included in the medical insurance,patients demand for new selected antipsychotics was released,but the increase of drug utilization rate was limited and still at a low level.The application of new selected antipsychotics was still restricted by the factors of medical insurance payment,hospitals’ and doctors’ behavior,patients’ choice and other relevant factors.The cost of new selected antipsychotics decreased after being included in the medical insurance,and the inpatient cost also decreased simultaneously,but the decrease was limited.The reimbursement level of patients patients using new selected antipsychotics was improved,and out-of-pocket expenses had been further reduced.However,the economic burden of patients using new selected antipsychotics remain heavy.It was difficult to guarantee the rights and interests of new selected antipsychotics under medical insurance for the disadvantaged groups.In order to ensure the implementation of new selected antipsychotics,the functions of compensation,payment and supervision of medical insurance should be given full play.To promote the use of new selected antipsychotics,the payment standard per bed day for schizophrenia should be appropriately raised and the medicare payment methods for schizophrenia should also be optimized.Multilevel medical security system should be used to raise the level of medical security for people in need and ensure their demand for medication.Measures such as strengthening assessment and supervision andmonitoring the application of new selected antipsychotics for medical insurance should be taken to promote the use of new selected antipsychotics.Meanwhile,in order to improve the efficiency of medical insurance funds,we should also establish a dynamic adjustment mechanism for the medicine catalogue of basic medical insurance.