| 引用本文：刘黎明, 程薇, 蒋艳, 赵丽颖, 徐阅, 娄翠迪, 马琳, 徐训航, 安垿钊, 满晓玮.北京市医药分开综合改革后慢性病人群治疗费用的机构流向分析——基于“SHA2011”[J].中国卫生政策研究,2021,14(4):11-17 |
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| 北京市医药分开综合改革后慢性病人群治疗费用的机构流向分析——基于“SHA2011” |
| 投稿时间：2021-03-01 修订日期：2021-04-10 PDF全文浏览 HTML全文浏览 |
| 刘黎明, 程薇, 蒋艳, 赵丽颖, 徐阅, 娄翠迪, 马琳, 徐训航, 安垿钊, 满晓玮 |
| 北京中医药大学 北京 100029 |
| 摘要:目的：慢性病在中国已成为影响人民健康水平的重大疾病。2017年4月8日，北京市全面实施医药分开综合改革，全面取消了药品加成。本文通过对北京市医药分开综合改革后慢性病不同受益人群治疗费用的机构流向的分析，为慢性病及分级诊疗相关政策的制定提供参考。方法：采用多阶段分层整群抽样调查的方法，以北京市24家医院、57家社区卫生服务中心为研究对象，利用卫生费用核算体系（SHA2011）核算2016—2017年北京市医院和社区中心慢性病患者治疗费用总量和受益人群的机构流向。结果：2017年，慢性病门诊费用由三级医院流向社区中心和二级医院，三级医院住院费用比重增加。男性和女性患者的机构流向与整体情况一致。15～59岁和60岁以上慢性病人群的门诊费用流向基层的比例升高。多数疾病别慢性病治疗费用流向三级医院的比例下降。结论：医药分开综合改革实施后，社区中心承担了更多的慢性病门诊服务，分级诊疗在一定程度上得到促进。 |
| 关键词:医药分开综合改革 慢性病 治疗费用 SHA2011 机构流向 |
| 基金项目:北京市卫生健康委员会资助项目“2019年基于SHA2011的北京市经常性卫生费用核算” |
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| Analysis of institutional distribution of treatment costs for patients with chronic disease after the comprehensive reform of medical-pharmaceutical separation in Beijing: Based on “SHA2011” |
| LIU Li-ming, CHENG Wei, JIANG Yan, ZHAO Li-ying, XU Yue, LOU Cui-di, MA Lin, XU Xun-hang, AN Xu-zhao, MAN Xiao-wei |
| Beijing University of Chinese Medicine, Beijing 100029, China |
| Abstract:Objective: Chronic diseases have become a major disease affecting people's health in China. On April 8, 2017, Beijing comprehensively implemented the comprehensive reform of medical-pharmaceutical separation, and completely cancelled the drug markup. This article analyzes the institutional distribution of treatment costs for different beneficiaries with chronic diseases after the comprehensive reform of Beijing's medicines separation, and provides a better data reference for the formulation of chronic diseases and hierarchical medical policies. Methods: A multi-stage stratified cluster sampling survey method was used, taking 24 hospitals and 57 community healthcare service centers in Beijing as the research objects, and employing the health expenditure accounting system (SHA2011) to account for chronic diseases in hospitals and communities in Beijing during the period from 2016 to 2017, and to compute total amount of chronic disease treatment costs and establish the distribution of healthcare institutions for beneficiaries. Results: In 2017, outpatient expenses for chronic diseases transferred from tertiary hospitals to communities and secondary hospitals, and the proportion of hospitalization expenses in tertiary hospitals significantly increased. The institutional distribution for male and female patients is consistent with the overall situation. The proportion of outpatient expenses for people aged 15~59 and over 60 with chronic diseases going to the primary healthcare institutions showed an increasing trend. The proportion of chronic disease treatment costs accounting to tertiary hospitals for most diseases had declined. Conclusions: After the implementation of the comprehensive reform of medical-pharmaceutical separation in Beijing, communities have increased their need to seek for chronic disease outpatient services, and the hierarchical medical system has been promoted to a certain extent. |
| Key words:Comprehensive reform of medical-pharmaceutical separation Chronic diseases Treatment cost Health Expenditure accounting 2011 Institutional distribution |
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