中国药业2025，Vol.34Issue(20)：14-17,4.DOI:10.3969/j.issn.1006-4931.2025.20.004
某儿童医院医保限制支付药品管理系统应用效果观察
Observation on the Application Effect of the Medical Insurance Restricted Payment Drugs Management System in A Children's Hospital
摘要
Abstract
Objective To promote rational drug use in children and provide references for hospitals to better implement medical insurance drug payment policies.Methods Taking a children's hospital as an example,the observation objects were pediatric drugs restricted for payment in the National Reimbursement Drug List for Basic Medical Insurance,Work-Related Injury Insurance,and Maternity Insurance.Department of Pharmacy collaborated with the Medical Insurance Office and of Department Information in the hospital developed the designed framework based on actual medication usage.A program was coded using PowerBuilder programming tool(using PowerScript language)in the hospital's information system,an Oracle database was used as the storage solution.A pop-up trigger mechanism was implemented to establish a medical insurance restricted payments drug management system.The data of illegal medication orders from the Jiangsu Provincial Medical Insurance Intelligent Supervision Platform from January to August 2023(before system intervention)and from September 2023 to April 2024(after system intervention)was extracted,and the improvement of the rationality of the use of medical insurance restricted drugs in the hospital was analyzed from three dimensions:medical insurance restricted payment categories,irrational drug classification,and specific irrational drug use.Results Compared with those before system intervention,after system intervention,the number of cases of irrational use of medical insurance restricted payment drugs decreased significantly(with a decrease of 89.35%),and the amount of irrational use decreased significantly(with a decrease of 78.45%);after intervention,the number of irrational drug use cases for most medical insurance restricted payment drugs decreased significantly,with the highest decrease for antibiotics(93.97%);the irrational use of 11 drugs including Compound Amino Acid Injection(14AA-SF)was disappeared;the number of cases of irrational use of 20 drugs decreased by≥70%.Conclusion This system is used for the management of medical insurance restricted payment for children's drugs,which can effectively reduce the irrational use of related drugs and improve the efficiency of hospital medical insurance drugs management.关键词
医保药品/儿童/限制支付/合理用药/管理系统Key words
medical insurance drug/children/restricted payment/rational drug use/management system分类
医药卫生引用本文复制引用
许锦,李炯,孙丽,刘彬,韩兆欢,刘育青,毛欣彤,赵兴辉,熊漠琛..某儿童医院医保限制支付药品管理系统应用效果观察[J].中国药业,2025,34(20):14-17,4.基金项目
国家卫生健康委能力建设和继续教育中心课题[GWJJ2023100303] （）
江苏省徐州市儿童医院科研项目[23040419]. （）
