Effect of reimbursement policy of basic medical insurance on the treatment level and cost of hemophilia A patients in China / 中华医院管理杂志

ABSTRACT

Objective:To explore the influence of differentiated outpatient reimbursement policies of basic medical insurance in some areas of China on the treatment level and medical expenses of adult hemophilia A patients.Methods:The outpatient reimbursement policies of hemophilia A in 5 cities(NB, XM, TJ, SY and ZZ)were systematically reviewed and compared. The basic characteristics, dosage of coagulation factors and medical expenses of hemophilia A patients in the 5 cities in 2018 were collected retrospectively to explore the influence of outpatient reimbursement policy on the treatment level and medical expenses of patients, and the differences of medical expenses between on-demand treatment and prophylaxis treatment were analyzed.Results:The reimbursement policies for hemophilia A outpatients in different regions were quite different. NB medical insurance had the best treatment, mainly reflected in the high reimbursement rate, no capping line(only urban employee medical insurance), and could be connected with major illness insurance; XM and TJ were relatively good, SY and ZZ were not ideal. The level of reimbursement of patients was also affected by their types of insurance. Adult patients of ZZ and SY were mostly covered by basic medical insurance for urban and rural residents, and their medical insurance benefits were relatively poor. In terms of treatment level, NB patients received the highest proportion of prophylaxis treatment(21 cases, 72.4%), followed by XM(8 cases, 26.7%), TJ(10 cases, 20.0%), and SY(5 cases, 10.2%), and no patients in ZZ received prophylaxis treatment. The areas with good reimbursement policy for outpatients were also accompanied by higher treatment costs, and the costs of prophylaxis treatment groups in each city were higher than those of the on-demand treatment group.Conclusions:At present, there are obvious differences in outpatient reimbursement treatment of hemophilia A patients in some areas of China. The standardization of patients receiving treatment is greatly affected by the level of medical insurance reimbursement. The improvement of reimbursement treatment will significantly improve the treatment level of patients, and also accompanied with higher medical expenses. The expenses of prophylaxis treatment group are higher than those of on-demand treatment group. It is suggested to further narrow the differences of reimbursement levels in different regions, and to improve the treatment level of patients with severe illness insurance, so as to reduce the burden of hemophilia A patients.