中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (05): 321-326.doi: 10.3969/j.issn.1671-4091.2023.05.001

• 调查研究 •    下一篇

中国大陆地区腹膜透析医保报销及诊疗收费情况的调查分析

中国医院协会血液净化中心分会   

  1. 中国医院协会血液净化中心分会
  • 收稿日期:2023-03-28 修回日期:2023-04-01 出版日期:2023-05-12 发布日期:2023-05-12
  • 通讯作者: 韦洮 E-mail:weitao63@163.com

Investigation and analyses on the peritoneal dialysis fees and the reimbursement from medical insurance in Chinese mainland

Chinese Hospital Association Blood Purification Center Branch   

  1. Chinese Hospital Association Blood Purification Center Branch
  • Received:2023-03-28 Revised:2023-04-01 Online:2023-05-12 Published:2023-05-12
  • Contact: 100044 北京，北京大学人民医院肾内科 E-mail:weitao63@163.com

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摘要： 目的  了解各地区关于腹膜透析医保报销及诊疗收费项目的情况，推动腹膜透析诊疗标准化收费和完善患者医保报销细则，减少患者负担并促进腹膜透析的发展。 方法 采用自行设计的腹膜透析项目及医保情况问卷，对除香港特别行政区、澳门特别行政区、西藏自治区外中国大陆30个省、自治区或直辖市的137家开设腹膜透析中心的医院进行问卷调查。对数据进行描述性统计分析，采用Kruskal-Wallis秩和H检验分析各组间差异。 结果 30个省、自治区或直辖市的居民、城镇职工、退休职工腹膜透析报销比例的中位数分别为80.0%(70.0%，85.0%)，85.0%(80.0%，90.0%)，90.0%(80.0%，90.0%)。每月持续性不卧床腹膜透析(continuous ambulatory peritoneal dialysis，CAPD)透析总费用低于自动化腹膜透析(automated peritoneal dialysis，APD)(H =26.717， P＜0.001)。随着每月CAPD或APD的总费用增高，每月可报销费用增高(H=58.367，P＜0.001)。腹膜透析费用存在较大的地区差异性。部分地区未设立出口处肉芽切除、废液袋项目、腹膜透析内涤纶套剥除项目、腹膜透析导管相关性隧道炎治疗等项目(地区比例分别为63%，60%，50%，47%)。常用的如敷贴、废液袋、消毒用品等保障腹膜透析治疗安全的一次性无菌用品，在77%的省市均无报销。 结论 本研究分析了目前腹膜透析管理存在的问题，并建议：①持续加强基本医保管理体制和运行机制研究，完善对腹膜透析医疗服务的激励机制；②完善腹膜透析诊疗收费项目，提高医疗机构提供腹膜透析治疗的积极性； ③增加可医保报销的腹膜透析诊疗项目，保障患者腹膜透析的安全及质量。

关键词: 腹膜透析, 医保报销, 诊疗项目

Abstract: Objective  To investigate the items and costs of peritoneal dialysis (PD) management and the reimbursement of the expenses by medical insurance in PD patients from different regions in China, in order to reduce the financial burden of the patients and to promote the use of PD through the standard items and prices of PD and the rational rules of reimbursement by medical insurance.  Methods  A self-designed questionnaire on PD items and medical insurance was used to investigate the PD patients in 137 hospitals that provide PD in 30 provinces and big cities in China. Descriptive statistical analysis was performed on the collected data, and Kruskal-Wallis rank sum H test was used to examine the differences among groups.  Results  The nationwide median rates of reimbursement by medical insurance were 80.0 (70.0, 85.0)%, 85.0 (80.0, 90.0)% and 90.0 (80.0, 90.0)% for residents, urban employees, and retired employees, respectively. The monthly expense of continuous ambulatory peritoneal dialysis (CAPD) was significantly lower than that of automated peritoneal dialysis (APD) (H=26.717, P＜0.0001). The monthly reimbursable amount increased with the monthly total expense of CAPD or APD (H=58.367, P＜0.001). The prices of PD varied significantly in different provinces and big cities. The prices of surgical removal of granulation tissue at the outlet, waste bag, removal of polyester cuff in PD tube, and treatment of PD catheter-related tunnel infections had not been set up in 63%, 60%, 50% and 47% provinces and big cities respectively. The commonly used disposable materials necessary for PD safety such as dressing, waste bag and disinfectants could not be reimbursed by medical insurance in 77% provinces and big cities.  Conclusions   This study analyzed the current administration situations of PD management. We therefore recommend that ①the organization and administration of the basic medical insurance system must be continuously reinforced, and the encouragement mechanisms underlying PD services must be improved; ② the prices of PD items should be properly adjusted to support the passions of the hospitals providing high quality of PD services, and ③ the reimbursable PD items are required to be increased to support the safety and quality of PD services.

Key words: Peritoneal dialysis, Medical insurance reimbursement, Diagnosis and treatment items

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