终末期肾病患者治疗费用负担分析与政策建议
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中国卫生资源 2018 年 3 月第 21 卷第 2 期 ［本文链接］http://doi.org/10.13688/j.cnki.chr.2018.17794
http: //chr.scdc.sh.cn
Hale Waihona Puke Baidu
121
·卫生经济·
终末期肾病患者治疗费用负担分析与政策建议
王文仪 1，梁鸿 1，芦炜 2 1. 复旦大学社会发展与公共政策学院，上海 200433 ；2. 海南师范大学经济与管理学院，海口 571158
10.13688/j.cnki.chr.2018.17794.
Analysis on treatment burden of end-stage renal disease patients and related policy suggestions WANG Wen-yi1，LIANG Hong1，LU Wei2/Address correspondence to LU Wei，E-mail ：vivianeluwei@163.com 1.School of Social Development and Public Policy，Fudan University，Shanghai 200433，China ；2.School of Economy and Management，Hainan Normal University，Haikou 571158，Hainan China 【Abstract】Objective To analyze the expenditure and composition of the maintenance renal replacement therapy（including dialysis and kidney transplant anti-rejection therapy）in patients with end-stage renal disease，and to estimate the economic cost so as to provide the basis for policy formulation and guarantee of health resources for end-stage renal disease. Methods Descriptive statistical analysis and T-test were used to analyze the time-series expenditure data of serious illnesses in dialysis patients and kidney transplant recipients in Shanghai insured patients. Results Firstly，the average annual expenditure of hemodialysis，peritoneal dialysis and kidney transplantation from 2007 to 2013 were 107 500 yuan，86 000 yuan and 112 200 yuan，respectively，increasing 5.18%，3.27% and 1.27%，respectively. Secondly，after eight years of continuous treatment，total treatment expenditure of hemodialysis，peritoneal dialysis and kidney transplant patients was 1.027 million yuan，871 600 yuan and 872 400 yuan. The treatment expenditure of hemodialysis was the highest. Thirdly， the hemodialysis patients who received treatment in tertiary hospital cost more than those in secondary hospital，while the expenditure of peritoneal dialysis had the opposite situation，and the kidney transplant was only allowed in tertiary hospitals. Conclusion It is recommended that peritoneal dialysis be promoted as a priority choice on the basis of economic suitability through the establishment of a hierarchical diagnosis and treatment health service network，optimization of the health insurance policy and provision of purposive incentive via DRGs. 【Keywords】end-stage renal disease ；peritoneal dialysis ；medical expense ；cost comparison
【摘要】目的 分析终末期肾病患者的维持性肾脏替代治疗（包括肾透析和肾移植抗排异）费用支出与构成，测算 经济成本，为终末期肾病卫生资源配置与保障政策制定提供依据。方法 对上海市医疗保险参保人中肾透析、肾移 植的大病标识人员时间序费用数据进行描述性分析和 t 检验。结果 2007—2013 年血液透析、腹膜透析、肾移植患 者年均费用分别为 10.75 万元、8.60 万元和 11.22 万元，涨幅分别为 5.18%、3.27% 和 1.27%。在连续治疗 8 年后，血 液透析、腹膜透析、肾移植患者累计支出治疗费用 102.70 万元、87.16 万元、87.24 万元，血液透析治疗支出最高。 在三级医院治疗的血液透析患者年均治疗支出高于在二级医院治疗的患者，腹膜透析则相反。结论 应基于经济 适宜性优先推广腹膜透析，手段包括建立腹膜透析三级诊疗服务体系，优化透析治疗的保障政策，通过病种管理 实现倾斜激励。 【关键词】终末期肾病 ；腹膜透析 ；医疗费用 ；成本比较 【引用】王文仪，梁鸿，芦炜，等 . 终末期肾病患者治疗费用负担分析与政策建议［J］. 中国卫生资源，2018，21（2）：121-126. DOI ：
http: //chr.scdc.sh.cn
Hale Waihona Puke Baidu
121
·卫生经济·
终末期肾病患者治疗费用负担分析与政策建议
王文仪 1，梁鸿 1，芦炜 2 1. 复旦大学社会发展与公共政策学院，上海 200433 ；2. 海南师范大学经济与管理学院，海口 571158
10.13688/j.cnki.chr.2018.17794.
Analysis on treatment burden of end-stage renal disease patients and related policy suggestions WANG Wen-yi1，LIANG Hong1，LU Wei2/Address correspondence to LU Wei，E-mail ：vivianeluwei@163.com 1.School of Social Development and Public Policy，Fudan University，Shanghai 200433，China ；2.School of Economy and Management，Hainan Normal University，Haikou 571158，Hainan China 【Abstract】Objective To analyze the expenditure and composition of the maintenance renal replacement therapy（including dialysis and kidney transplant anti-rejection therapy）in patients with end-stage renal disease，and to estimate the economic cost so as to provide the basis for policy formulation and guarantee of health resources for end-stage renal disease. Methods Descriptive statistical analysis and T-test were used to analyze the time-series expenditure data of serious illnesses in dialysis patients and kidney transplant recipients in Shanghai insured patients. Results Firstly，the average annual expenditure of hemodialysis，peritoneal dialysis and kidney transplantation from 2007 to 2013 were 107 500 yuan，86 000 yuan and 112 200 yuan，respectively，increasing 5.18%，3.27% and 1.27%，respectively. Secondly，after eight years of continuous treatment，total treatment expenditure of hemodialysis，peritoneal dialysis and kidney transplant patients was 1.027 million yuan，871 600 yuan and 872 400 yuan. The treatment expenditure of hemodialysis was the highest. Thirdly， the hemodialysis patients who received treatment in tertiary hospital cost more than those in secondary hospital，while the expenditure of peritoneal dialysis had the opposite situation，and the kidney transplant was only allowed in tertiary hospitals. Conclusion It is recommended that peritoneal dialysis be promoted as a priority choice on the basis of economic suitability through the establishment of a hierarchical diagnosis and treatment health service network，optimization of the health insurance policy and provision of purposive incentive via DRGs. 【Keywords】end-stage renal disease ；peritoneal dialysis ；medical expense ；cost comparison
【摘要】目的 分析终末期肾病患者的维持性肾脏替代治疗（包括肾透析和肾移植抗排异）费用支出与构成，测算 经济成本，为终末期肾病卫生资源配置与保障政策制定提供依据。方法 对上海市医疗保险参保人中肾透析、肾移 植的大病标识人员时间序费用数据进行描述性分析和 t 检验。结果 2007—2013 年血液透析、腹膜透析、肾移植患 者年均费用分别为 10.75 万元、8.60 万元和 11.22 万元，涨幅分别为 5.18%、3.27% 和 1.27%。在连续治疗 8 年后，血 液透析、腹膜透析、肾移植患者累计支出治疗费用 102.70 万元、87.16 万元、87.24 万元，血液透析治疗支出最高。 在三级医院治疗的血液透析患者年均治疗支出高于在二级医院治疗的患者，腹膜透析则相反。结论 应基于经济 适宜性优先推广腹膜透析，手段包括建立腹膜透析三级诊疗服务体系，优化透析治疗的保障政策，通过病种管理 实现倾斜激励。 【关键词】终末期肾病 ；腹膜透析 ；医疗费用 ；成本比较 【引用】王文仪，梁鸿，芦炜，等 . 终末期肾病患者治疗费用负担分析与政策建议［J］. 中国卫生资源，2018，21（2）：121-126. DOI ：