Research On The Current Situation Of Drug Use And Medical Insurance Payment For Outpatients With Four Chronic Diseases In A Tertiary Hospital

ObjectiveTo study the situation of drug using and medical insurance payment of chronic diseases(Diabetes mellitus,Hypertension,Chronic Obstructive Pulmonary Disease,Lung Cancer)in a top three hospital in Xiamen,make recommendations for reducing unnecessary medical expenses,easing the burden of individual illness,controlling the cost of medical resources,reducing the waste of medical resources and ensuring the long-term development of medical insurance.MethodsBy using analysis method of Defined Daily Dose to calculate the Defined Daily Dose system and daily expense of diabetes to study the situation of drug using and medical insurance payment of 42159 chronic diseases patients in a top three hospital in Xiamen,Subjects included Diabetes patients 8459,hypertension patients 27825,chronic obstructive pulmonary disease patients 3141,lung cancer patients 2734.By using the statistical analysis including descriptive statistics,rank sum test,chi-square test,multiple stepwise regression analysis,in order to provide recommendations for reducing the irrational use of drugs effectively,controlling the irrational cost of drugs and medical insurance costs.ContentsAnalysising the situation of drug using,including Defined Daily Dose,Defined Daily Dose system,Defined Daily Cost,order ratio and the amount of sales,of chronic diseases(Diabetes mellitus,Hypertension,Chronic Obstructive Pulmonary Disease,Lung Cancer),discussing the rationality of patients with the four chronic diseases.Analysising the situation of prescription drugs,non-prescription drugs and medical expenses and health insurance payments of diabetes,hypertension,chronic obstructive pulmonary disease,lung cancer patients with different types of medical insurance.Result(1)In 2015 the hospital outpatient was patients 719492 total,medical expenses was a total of 142 million yuan,secondary medical expenses was 198.12 yuan;Sub-average drug cost 90.94 yuan,sub-check cost 36.46 yuan;Outpatient drug share was 45.85%.(2)Diabetes patients were 8459,medical expenses was a total of 2.118 million yuan,secondary medical expenses was 249.53 yuan;Sub-average drug costs 226.14 yuan,drug shared 90.62%,which was far higher than the average level in hospital.The average prescription drug fee was 222.39 yuan;Sub-non-prescription drugs was 3.14 yuan.The medicare payment of Diabetes patients is 1.5197 million yuan,accounting for 71.68%of total medical expenses;Personal pays 597,700 yuan by themselves,accounting for 28.32%.(3)Hypertension patients were 27825,medical expenses was a total of 5.9249 million yuan,secondary medical expenses was 212.93 yuan,which was higher than the average level in hospital outpatient;Sub-average drug costs 177.05 yuan,drug shared 83.14%.The average prescription drug fee was 169.85 yuan;Sub-non-prescription drugs was 6.84 yuan.The medicare payment of Hypertension patients is 4.6705 million yuan,Personal pays 1.2545 million yuan by themselves,accounting for 21.17%.(4)Chronic obstructive pulmonary disease patients were 3141,medical expenses was a total of 1.00 million yuan,secondary medical expenses was 318.37 yuan,which was higher than the average level in hospital outpatient;Sub-average drug costs 258.83 yuan,drug shared 81.30%.The most commonly used drugs was inhalation preparations,consistenting with the recommendation of the 2015 Guidelines for Chronic Obstructive Pulmonary Disease.The average prescription drug fee was 249.83 yuan;Sub-non-prescription drugs was 7.39 yuan.accounting for 2.32%of the average medical expenses.The medicare payment of Chronic obstructive pulmonary disease patients is 0.64 million yuan,Personal pays 0.36 million yuan by themselves,accounting for 35.79%.(5)Lung tumor patients were 2734,medical expenses was a total of 0.53 million yuan,secondary medical expenses was 195.06 yuan,which was lower than the average level in hospital outpatient;Sub-average drug costs 91.77 yuan,drug shared 47.05%.The average prescription drug fee was 87.10 yuan;Sub-non-prescription drugs was 1.09 yuan,accounting for 0.56%of the average medical expenses.The medicare payment of Lung tumor patients is 0.29 million yuan,Personal pays 0.24 million yuan by themselves,accounting for 45.75%Conclusions(1)Hospital medical expenses:The secondary medical expenses,the average cost of drugs,sub-inspection fees of this hospital were lower than the average level of the national and Fujian Province;Drug share of outpatient was lower than the national average,and slightly higher than the average level of Fujian Province.(2)Drug costs of chronic diseases Diabetes,high blood pressure and chronic obstructive pulmonary disease medical expenses of this hospital was main the cost of drugs costs,the proportion of drug costs far more than the hospital average.Therefore,to develop drug costs control measures according to the type of disease.(3)Drug using of chronic diseases:The use of drugs which treat four kinds of chronic diseases is basically reasonable in this hospital,but there is an excessive use of individual drugs,such as Aspirin enteric-coated tablets,amoxicillin/clavulanate tablets;and first-line drug metformin use frequency is insufficient.(4)Medicare payments:The proportion of hospital patients to pay slightly lower than the average of national personal health expenditure level.But the individual patients personal pays to partion disease is much still,such as lung cancer and chronic obstructive pulmonary disease.(5)Effects of prescription drugs and non-prescription drugs on medical expenses:Prescription drugs have a greater impact on medical expenses for chronic patients;Non-prescription drug costs are lower and the economic burden on patients is smaller;2017 new medical insurance drug directory,adds 339 kinds of drugs which is not including non-prescription.