| 引用本文：冷家骅, 刘忆, 陈治水, 郭军.北京市医药分开综合改革对肿瘤专科医院的影响——基于北京某肿瘤医院医保数据的实证分析[J].中国卫生政策研究,2017,10(12):15-21 |
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| 北京市医药分开综合改革对肿瘤专科医院的影响——基于北京某肿瘤医院医保数据的实证分析 |
| 投稿时间：2017-06-14 修订日期：2017-10-18 PDF全文浏览 HTML全文浏览 |
| 冷家骅, 刘忆, 陈治水, 郭军 |
| 北京大学肿瘤医院暨北京市肿瘤防治研究所 恶性肿瘤发病机制及转化研究教育部重点实验室 北京 100142 |
| 摘要:目的：分析北京市医药分开综合改革对肿瘤专科医院医保人群收治产生的政策影响，为改革的进一步开展和调整提供依据。方法：运用间断时间序列数据的分段回归模型，分析某肿瘤医院医保的门诊、住院、特种病的服务利用情况，以及其中药占比和患者自付比等在改革后的即时变化和趋势变化。结果：肿瘤治疗存在相对特异性，肿瘤专科医院的既往住院药占比介于49.31%~49.96%之间、实际补偿比介于57.05%~63.57%之间。医药分开综合改革后，案例医院医保人群的费用负担水平出现即刻变动并且呈现趋势变化，门诊人群次均费用的改革变化为-4.33元/月、实际负担率的改革变化为-2.32%/月；药占比下降，改革后门诊与住院药占比分别出现4.63%、2.98%的下降；材料占比有所升高，改革后门诊与住院材料占比分别出现0.22%、1.17%的上涨。结论：改革减弱了医院对药品收入的依赖，减轻了患者负担，但肿瘤治疗存在刚性需求，对医院财务以及基金会带来相对大的冲击，并且需要考虑费用平移后费用去向的临床合理性。 |
| 关键词:医药分开 医疗服务价格 肿瘤专科 医疗保险 间断时间序列 |
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| Impact of separating drug sales from medical services reform on Beijing Cancer Hospital from the perspective of medical insurance data |
| LENG Jia-hua, LIU Yi, CHEN Zhi-shui, GUO Jun |
| Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research(Ministry of Education), Beijing 100142, China |
| Abstract:objective:To analyze the policy impact of separating drug sales from medical services on a certain oncology hospitals in Beijing, and provide the basis for further development and adjustment of the reform. Methods:Using interrupted time series segmented regression model to analyse the instant change and trend change of medical service utilization by outpatient (including tumor-specified outpatient) and overall inpatient services, especially in indicators of drug proportion, self-pay ratio, and so on after the reform. Results:Tumor treatment is a relative specificity. The proportion of previous inpatients in tumor specialized hospitals ranged between 49.31% and 49.96%, and the actual compensation rates were between 57.05% and 63.57%. In our case analysis, the expenditure of outpatients dropped after this reform, with RMB 4.33 monthly decline on average cost and with 2.32 percentage monthly decrease on a self-pay rate. Drug proportion was declined expectedly, and the proportion of outpatient and inpatient drugs immediately decreased by 4.63% and 2.98% respectively after the reform. Therewith consumptive material proportion was raised, and the proportion of outpatient and inpatient materials instantly increased by 0.22% and 1.17% respectively. Conclusion:As per the results of this study, the reform has weakened the economic dependence on drug income in sample hospital and reduced the burden on patients. However, tumor treatment is on rigid demand and brings about a relatively great impact on hospital's finance and medical insurance fund. The rationality regards of cost-shifting should be investigated in the long run. |
| Key words:Separating drug sales from medical services Medical service price Oncology Medical insurance Interrupted time series |
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