关键词: font-size:medium, ">持续葡萄糖监测技术；医保报销；预算影响分析；医院管理视角

Abstract: Objective：The reimbursement policies for continuous glucose monitoring (CGM) vary across different provinces and cities in China. This study aims to assess the budget impact of CGM reimbursement on medical insurance from the hospital perspective, considering both inpatient and outpatient scenarios. Methods： A tertiary hospital assuming 10,000 people with diabetes was taken as an example to build up the budget impact model from the hospital administrator perspective. The incremental expenditures of medical insurance fund in the next three years (2022—2024) were calculated to estimate the budget impact brought by policy changes of CGM reimbursement. The model included the cost of glucose monitoring service items and consumables, the cost of outpatient visits, hospitalization costs, and treatment costs of acute complications. We assumed that none of the CGM service items and consumables was reimbursed at first, and the scope of reimbursement followed a stepwise expansion from inpatient service items, inpatient consumables, outpatient service items to outpatient consumables. Results：For a tertiary hospital treating 10,000 diabetes patients yearly, if the CGM service items and consumables are reimbursed in both inpatient and outpatient settings, the annual expenditure of medical insurance fund was expected to increase by CNY 255～394 thousand with an increase of CNY 39～60 per capital in 2022—2024. CGM provides rich data on glucose fluctuations and can potentially reduce the hospitalization caused by poor glucose control. This benefit was translated to a saving of hospitalization cost and treatment cost of inpatient acute events, which was estimated as CNY 160～252 thousand annually. Conclusion： This study found that the reimbursement of CGM resulted in an increase in the expenditure of glucose monitoring items and consumables. However, the regular glucose monitoring could facilitate diabetes management and enable better disease control, which could reduce expenditures in hospitalization and acute complications.

Key words: Continuous glucose monitoring, Reimbursement, Budget impact analysis, Perspective of hospital administrators