| 引用本文：王俊锋, 崔斌, 魏霞, 杨莉.北京市医药分开综合改革对服务利用的影响——以缺血性心脏病住院患者为例[J].中国卫生政策研究,2019,12(11):45-52 |
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| 北京市医药分开综合改革对服务利用的影响——以缺血性心脏病住院患者为例 |
| 投稿时间：2019-04-18 修订日期：2019-10-23 PDF全文浏览 HTML全文浏览 |
| 王俊锋, 崔斌, 魏霞, 杨莉 |
| 北京大学公共卫生学院 北京 100191 |
| 摘要:目的：了解北京市2017年医药分开综合改革对患者医疗服务利用的影响。方法：数据来源于2016-2017年北京市医保抽样数据库；采用中断时间序列回归和倍差法分析北京市所有公立医院患者改革前后服务利用变化。结果：北京市医药分开综合改革对缺血性心脏病住院患者总费用、基金付费、自付费用的影响较小。住院患者西药费用瞬时水平降低（P<0.001）；高值影像检查费用瞬时水平降低（P<0.05）；医疗服务费用瞬时水平显著上升（P<0.001），且长期有持续上升的趋势。改革后门诊总费用和门诊药品费用均显著降低（P<0.05），西药费用和中药费用也显著下降（P<0.05）。结论：北京市医药分开综合改革，改变了患者医疗费用结构，西药费用降低，服务费用增加，可能存在预期外的耗材费用增长。 |
| 关键词:医药分开 综合改革 卫生服务利用 医疗费用 评价 |
| 基金项目:国家自然科学基金面上项目（71673004，71911530221） |
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| The impact of separating drug sales from medical services on medical resource utilization and medical expense in Beijing: Take inpatients with ischemic heart disease for example |
| WANG Jun-feng, CUI Bin, WEI Xia, YANG Li |
| School of Public Health, Peking University, Beijing 100191, China |
| Abstract:Objective:To know about the situation of implementing the separation of drug sales from medical services in public hospital in Beijing, and evaluate the impacts of the reform on medical resources utilization. Methods:This paper used the 2016-2017 Data from Beijing sampled claim database. The interrupted time series (ITS) design was mainly employed to evaluate the changes in medical services utilization and expenses among patients with ischemic heart disease. Results:The changing of the hospitalization expenses, insurance expenses and out-of-pocket expenses showed no significant difference. The western medicine expenses (P<0.001) showed a decreasing trend. The expenses charged to hospitalized patients for imaging examination decreased, especially for the large-scale medical equipment where it was noticed a significant decrease(P<0.05). The medical service expenditure greatly increased (P<0.001).For the outpatient, the total expenses and medicine expenses had greatly decreased (P<0.05). Conclusions:The 2017 comprehensive policy of the separation of drug sales from medical services exerted a great change on the income structures of pilot hospitals, whereby the drug expenses underwent a decreasing trend and the treatment service expenses showed a slight increase. And there was a potentially unintended increase in medical disposable material expenses. |
| Key words:Separation between medical and pharmaceutical seruces The comprehensive reform Health service utilization Medical expenses Evaluation |
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