目的: 通过病种费用对比分析国家组织人工关节集采成效。方法: 利用疾病诊断相关分组对宁波市11家三级医院髋关节置换、膝关节置换的病案首页数据进行分组,分析人工关节集采前后病例数、平均住院日、病种费用的变化。结果: 人工关节集采后（2022年6月—9月）与集采前（2022年1月—4月）相比,髋关节置换和膝关节置换的住院均费分别显著降低22.50%（p<0.01）和20.51%（p<0.01）,其中耗材费分别降低41.73%（p<0.01）和33.00%（p<0.01）,但药品费增长16.15%和12.98%,平均住院日分别延长了12.46和2.96%。结论: 集采有效促进人工关节价格回归合理水平,相关病种住院费用下降明显,减轻患者就医负担。但不同医院间病种费用结构差异较大,建议医保部门强化对集采耗材的采购监督,医疗机构要完善集采耗材使用的内控考核,加强对病种费用的精细化管控。

Objective: The paper analyzes the effect of national centralized procurement of artificial joint through comparison of disease cost. Methods: According to the medical records of first page in 11 hospitals paid by diagnosis-related groups to hip joint replacement and knee joint replacement, the changes of case number, average hospitalization days, and disease costs were analyzed before and after national centralized procurement of artificial joints. Results: Compared with before the national centralized procurement of artificial joints (June to September 2022), after the procurement of (January to April 2022), the average hospitalization costs of hip joint replacement and knee joint replacement were significantly reduced by 22.50% (p<0.01) and 20.51% (p<0.01) respectively, in which the cost of medical consumable decreased by 41.73% (p<0.01) and 33.00% (p<0.01), but the cost of drugs increased by 16.15% and 12.98%, and the average hospitalization days were extended by 12.46% and 2.96% respectively. Conclusions: National centralized procurement of artificial joints can effectively promote the price of artificial joints to return to a reasonable level, and the hospitalization expenses of related diseases can be significantly reduced, which can effectively reduce the burden of patients. However, there are great differences in the cost structure of disease types among different hospitals. It is suggested that the medical insurance department should strengthen the supervision of centralized procurement of consumables, and medical institutions should improve the internal control assessment of centralized procurement of consumables, and strengthen the refined control of the cost of disease types.