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县级公立医院医药分开改革对医院收入和医疗服务的影响——基于广西的实证分析
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| 投稿时间： 2015-03-25 最后修改时间： 2015-04-27 摘要点击次数: 3085 全文下载次数: 1396 |
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| 引用本文：赵锋, 杨莉, 张旭光,等.县级公立医院医药分开改革对医院收入和医疗服务的影响——基于广西的实证分析[J].中国卫生政策研究,2015,8(5):24-30 |
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| 赵锋, 杨莉, 张旭光, 李欣雅, 温连奎, 孙黎 |
| 北京大学公共卫生学院 北京 100191 |
| 基金项目:国家自然科学基金面上项目(71273016); 教育部人文社会科学研究青年基金项目(10YJC630332) |
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| | 摘要:目的:评价广西县级公立医院医药分开改革对医院收入和医疗服务的影响.方法:采用前后对照设计,2009—2012年为干预前,2013年为干预期,试点县级公立医院为干预组,非试点县级公立医院为对照组;数据来源于2009—2013年医院统计报表和新农合报表、2010—2014年广西统计年鉴;采用基于回归的倍差法进行分析.结果:医药分开改革包括取消药品加成、提高诊查费和护理费项目价格、降低大型设备检查项目价格和增加财政补助;在医院收入方面,相对于非试点医院,试点医院药品收入减少332.6万元、医疗收入增加1 075万元,财政补助没有显著变化;在医疗费用方面,相对于非试点医院,试点医院次均门诊药品费用减少3.51元、次均门诊诊查费用增加2.23元、次均住院药品费用减少133.50元、次均住院诊查费用增加62.01元、次均住院护理费用增加69.72元,门诊和住院人次、平均住院日、次均门诊和住院费用均无显著变化.结论:县级公立医院住院医疗服务价格调整弥补了取消药品加成带来的损失,门诊需通过政策外项目费用调整来弥补损失.医药分开改革没有减少试点医院业务收入,但对医院和医生的激励作用有限. | |
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关键词:医药分开 医院收入 服务利用 医药费用 倍差法
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| Effect of separating drug sales from medical services on hospital revenue and medical services in the county public hospitals of Guangxi Province |
| ZHAO Feng, YANG Li, ZHANG Xu-guang, LI Xin-ya, WEN Lian-kui, SUN Li |
| School of Public Health, Peking University, Beijing 100191, China |
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| | Abstract:Objective: To evaluate the effect of separating drug sales from medical services on hospital revenue and medical services in the county-level public hospitals of Guangxi. Methods: The controlled before and after study design was employed. 2009 to 2012 was the pre-intervention period; 2013 was the intervention period. Pilot people's hospitals were included in the intervention group; non-pilot people's hospitals were included in the control group. Data came from hospitals and new rural cooperative medical statistics from 2009 to 2013 and the Guangxi Statistical Yearbook from 2010 to 2014. The analysis method of difference-in-differences based regression was employed. Results: Separating drug sales from medical services included cancelling medicine markups, increasing price of inspection and nursing services, reducing price of large equipment inspection services and increasing financial assistance. In terms of hospital revenue, compared with non-pilot hospitals, for pilot hospitals, the reform reduced medicine revenues by 3.326 million yuan and increased medical revenue by 10.75 million yuan. There was no significant change in financial assistance. In terms of medical expenses, compared with non-pilot hospitals, the reform reduced per-visit outpatient drug expenses in pilot hospitals by 3.51 yuan, increased per-visit outpatient inspection fees by 2.23 yuan, reduced per-visit inpatient drug expenses by 133.5 yuan, increased per-visit inpatient inspection fees by 62.01 yuan, and increased per-visit inpatient nursing fees by 69.72 yuan. There were no significant change in outpatient and inpatient visits, length of stay, outpatient expenses per-visit and inpatient expenses per-visit. Conclusion: County hospitals can offset losses due to cancelling medicine markups by medical service pricing adjustment in inpatient departments; in outpatient departments, they can offset losses due to cancelling medicine markups by both medical service pricing adjustments and medical service utilization adjustments beyond policy adjustments. The reform did not reduce the operating revenue of pilot hospitals or the medical expenses per visit. The reform had little effect on hospital and doctor incentives. | |
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