目的: 比较“双通道”管理机制下医疗机构门诊（院内）和零售药店（院外）两个渠道高值药品使用特征与变化趋势,探究高值药品院外用药行为的个体层面影响因素。方法: 采集2019—2023年威海市全体参保人医保结算记录数据与相关政策文本,以五年间在医疗机构门诊或零售药店有过高值药品使用及报销记录的参保患者为研究对象,采用描述性统计分析方法,横向比较院内外两个渠道、纵向比较5个自然年度间用药人数、人次数、费用等指标差异;采用Heckman样本选择模型,从院外购药概率、院外用药比重两个方面量化院外用药行为,从个体特征、疾病特征、治疗特征三个维度开展影响因素分析。结果: 2019—2023年间威海市高值药品用药人数、人次数、费用年均增幅分别为47.67%、78.72%、24.89%,其中,院外用药人数、人次数、费用年均增幅81.95%、135.77%、63.57%,相应占比亦逐年提升,于2023年达到87.41%、88.60%、88.05%。Heckman模型估计显示,与2019年相比,2020—2023年高值药品院外用药行为更为突出（P<0.01）,四年来院外购药概率分别显著增加82.5%、149.5%、179.7%和169.9%。结论: “双通道”管理机制推动高值药品使用快速增长,处方外流趋势明显;患者院外用药行为存在显著年龄趋势,肿瘤类疾病、高药费负担、长用药周期、低院内用药次数等是患者高值药品院外用药行为的重要推动因素。

Objective: The paper compared the utilization characteristics and trends of the high-value drugs between hospital outpatients (in-hospital) and retail pharmacies (out-of-hospital) under the “dual-channel” policy, and empirically analyzed the factors influencing patients' out-of-hospital medication behavior of high-value drugs at the individual level. Methods: We collected medical insurance reimbursement records of all insured patients in Weihai City, Shandong Province from 2019 to 2023 and relevant policy documents. Patients who had utilized and reimbursed the high-value drugs within the five years were selected as study samples. Descriptive statistical analysis was used to compare the differences in the number of patients, visits, and costs between the two channels (in-hospital and out-of-hospital) and across the five civil years. The Heckman sample selection model was employed to quantify hospital medication behavior from two aspects: the probability of out-of-hospital drug procurement and the proportion of out-of-hospital medication, and identify the influencing factors of out-of-hospital medication behavior from the dimensions of individual characteristics, disease characteristics, and treatment characteristics. Results: From 2019 to 2023, the average annual growth of the number of patients, visits, and costs for high-value drugs in Weihai City was 47.67%, 78.72%, and 24.89%, in which out-of-hospital channel increased by 81.95%, 135.77%, and 63.57% and the corresponding proportion reached 87.41%, 88.60%, and 88.05% by 2023. The results of Heckman model showed that compared to 2019, the out-of-hospital medication behavior for high-value drugs became more prominent from 2020 to 2023 (P<0.01). The probability of out-of-hospital drug procurement has significantly increased by 82.5%, 149.5%, 179.7%, and 169.9% in the past four years. Conclusions: The “dual-channel” policy promotes a rapid utilization increase of the high-value drugs, with a prominent trend of prescription outflow. Patients' out-of-hospital medication behavior has significant age trends, and is driven by factors such as cancer, heavy medication burden, long medication cycles, and low frequency of in-hospital medication.