目的: 早期门诊用药是高血压、糖尿病等基础慢病治疗和控制病情进展的关键手段,本文基于用药视角,旨在摸清门诊保障政策下老年“两病”患者门诊药品资源消耗特征,并实证分析门诊用药对其住院服务利用与费用的影响效应。方法: 采集2019—2023年W市所有参保人参保与就医结算资料,以享受门诊慢特病保障且有医保定点医药机构就诊记录的老年“两病”患者为研究对象,区分不同医保类型与档次三类人群（居民一档、居民二档、职工医保）。以住院服务利用与费用指标为被解释变量、门诊用药次数与门诊用药程度为解释变量,构建个体–年份双向固定效应模型。结果: 共计纳入老年“两病”患者140283人,平均年龄72.2±7.7岁。多数患者年均门诊用药≥4次,年均门诊药品费用由2019年1848.6元/人递减至2023年888.3元/人,年门诊用药次数、门诊药品费用均呈现“居民一档<居民二档<职工医保”趋势,门诊药占比为96.1%。患者住院概率、住院次数、住院天数随门诊用药次数与用药程度增加而显著递减（P<0.01）,在不同医保档次人群中具有一致性。住院医疗费用与药品费用在较高门诊用药次数组别患者中显著下降（P<0.01）,但随门诊用药程度增加呈倒“U”形分布。结论: 老年“两病”群体的核心门诊需求是用药,其药品利用情况因医保待遇、合并症、并发症等情形而异。慢性病门诊保障机制下,引导患者在门诊充分、合理用药治疗,有利于“置换”住院医疗服务,节省住院费用。
Abstract
Objective: Early outpatient medication is a critical means for the treatment and control of the progression of chronic diseases such as hypertension and diabetes. This study attempts to characterize the outpatient drug consumption of elderly patients with hypertension and diabetes under the outpatient security policy, and to analyze the effects of outpatient medication on inpatient service utilization and costs. Methods: Basic medical insurance participation and claim data of all insured residents in W city from 2019 to 2023 were collected. Elderly patients with hypertension and/or diabetes who are entitled to the outpatient chronic and special disease medical security policy and have visiting records at designated medical institutions were selected as study samples, dividing into three groups of people with different types and levels of medical insurance (residents level 1, residents level 2, and employees). The two-way fixed-effect model was constructed, with inpatient service utilization and cost indicators as the dependent variables, outpatient medication frequency and extent as the independent variables. Results: 140283 elderly patients with hypertension and diabetes were included, with an average age of 72.2±7.7 years old. Most patients had an average outpatient medication frequency of greater than or equal to 4 visits per year, the annual outpatient drug costs per capita decreased from 1848.6 yuan in 2019 to 888.3 yuan in 2023, and the annual outpatient medication frequency and outpatient medication costs show a trend of "residents level 1<residents level 2<employees", with total outpatient drug costs accounting for 96.1%. The probability, frequency, and length of hospitalization significantly decreased with the increase of outpatient medication frequency and extent (P<0.01), which is consistent among people with different levels of medical insurance. Inpatient medical costs and drug costs decreased significantly in the group with higher outpatient medication frequency (P<0.01), but showed an inverted U-shaped distribution with the increase of outpatient medication extent. Conclusion: The core outpatient demand of elderly patients with hypertension and diabetes is medication, and their medication utilization varies by medical insurance levels, comorbidities, and complications. Under the outpatient security mechanism of chronic disease, guiding adequate and rational outpatient medication is conducive to the “replacement effect” on inpatient medical services and the decrease of inpatient costs.
关键词
门诊用药保障 /
高血压 /
糖尿病 /
老年人
Key words
outpatient medication security /
hypertension /
diabetes /
the elderly
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基金
国家资助博士后研究人员计划（GZC20240534）
