中国卫生事业管理2025，Vol.42Issue(12)：1365-1371,7.
"十三五"至"十四五"期间医疗费用结构变迁与政策效应分析
Analyz the Change of Medical Expenses Structure and Policies Impact from the Period of 13th Five-Year Plan to 14th Five-Year Plan Based on Empirical Study of Data of Breast Cancer Patients in One General Tertiary First-Class Hospital
摘要
Abstract
Objective To systematically analyze the trends of medical expenses,structural characteristics,and the impact of medical reform policies based on the data of breast cancer patients admitted to a general tertiary first-class hospital in Beijing,fo-cusing on the influence of medical insurance policy adjustments on the structure of patients' medical expenditures and their actual personal economic burden,and explore the current status and development strategies of domestic breast cancer diagnosis and treat-ment cost management and medical security effectiveness.Methods Medical expense data of breast cancer patients admitted to a general tertiary first-class hospital in Beijing were analyzed by using structural change analysis and event study methodology.Re-sults From 2013 to 2023,the average total inpatient expense of breast cancer patients in this hospital increased by 68.84％,while the average personal out-of-pocket expense during the same period increased by 46.84％,which was significantly lower than the growth rate of total inpatient expenses.The out-of-pocket ratio decreased from 33.27％in 2013 to 26.96％in 2022.The out-of-pocket ratio of patients over 60 years old had stably dropped below 30％,while that of patients aged 10～29 remained at a relatively higher level.Among the inpatient expenses of breast cancer patients,the proportions of pathological examination fees,surgical fees,material fees,laboratory test fees,drug fees,examination fees,and consultation fees exceeded 3％.The proportion of expense-controlled items decreased,while the proportion of diagnosis and treatment service items increased.After the compre-hensive reform of separating medical from pharmaceutical services in Beijing in 2017,the total hospitalization expenses for breast cancer patients increased at a higher rate.The proportion of out-of-pocket expenses showed a downward trend,but the rate of decrease slowed down.Conclusion The overall medical expenses showed an upward trend,but the personal burden of breast cancer patients continued to decrease,with significantly different burden among different age groups.The structure of medical expendi-tures was continuously optimized,and the structural changes were significantly regulated by policies.The 2017 comprehensive re-form of separating medical treatment and drug sales in Beijing had a significant regulatory effect on the expenses of breast cancer patients,verifying the effectiveness of the policy in optimizing the expense structure of breast cancer diagnosis and treatment and balancing the value of medical services and patients' burden.Based on which,it is recommended to consolidate the effectiveness of medical insurance burden reduction,establish a dynamic monitoring and early warning mechanism for breast cancer medical ex-penses,balance"cost control"and"efficiency improvement",expand the scope of centralized procurement of drugs,develop a classified bargaining mechanism for high-value consumables,promote dynamic adjustment of diagnosis and treatment service prices,strengthen cross-departmental policy coordination,construct a long-term evaluation mechanism for medical reform poli-cies including cost trends,out-of-pocket ratios,and patient satisfaction,which can systematically optimize the management of breast cancer diagnosis and treatment expenses,and enhance the efficiency of medical security.关键词
医疗费用结构/政策效应/乳腺癌/结构变动度Key words
medical expense structure/policy effect/breast cancer/structural variability分类
医药卫生引用本文复制引用
张英楠,王常珺,周蜜,邱书琳,胡雅洁.."十三五"至"十四五"期间医疗费用结构变迁与政策效应分析[J].中国卫生事业管理,2025,42(12):1365-1371,7.基金项目
国家医疗保障局立项课题"'十四五'中后期降低个人就医负担路径研究"(第2023006号) （第2023006号）
