取消以药补医对县级医院服务量及效率的影响  

The Impact of Abolishing Drug Make-up on Service Volume and Efficiency in County-level Hospitals

作　　者：白洁[1,2] 荆丽梅 孙晓明 娄继权 崔欣 

机构地区：[1]上海市浦东卫生发展研究院,上海200129 [2]复旦大学公共卫生学院,上海200032 [3]上海市浦东新区卫生和计划生育委员会,上海200125

出　　处：《中国卫生经济》2015年第6期39-43,共5页Chinese Health Economics

基　　金：上海市浦东新区卫生系统优秀青年医学人才培养(PWRq2013-21);中国卫生经济学会招标课题(CHEA1213040303);2014年浦东新区卫生科技项目(PW2014A-4)

摘　　要：目的:评价我国县级公立医院实施取消以药补医政策后对医院服务量及服务效率的影响。方法:在东、中、西部分别选取具有典型代表性且改革时间相近的三个地区共22所县级公立医院,运用比率分析法分析其改革前后的变化,并与全国同期水平相对比。结果:取消以药补医政策实施后,样本地区的医疗服务量加速增长,高于全国平均水平,住院服务量的涨幅高于门急诊服务量的增长。两个测量机构病床使用效率的指标在改革后均由下降变为好转。每职工平均门急诊人次数减速增长,每职工平均住院床日加速增长。结论与建议:取消以药补医政策在医疗服务量及服务效率方面取得了良好的效果,对住院服务的作用大于门急诊服务。如果配合合理的绩效考核方式和收入分配制度,取消以药补医改革可以在医院收入增加的同时提升医务人员的收入。Objective:To assess the impact of abolishing drug make-up on service quantity and efficiency in county-level publichospitals of China.Methods:Through analyzing 22 county-level public hospitals abolishing drug make-up policy in 3 typical repre-sentative regions with closer reforming time chosen from eastern, central and western regions, ratio analysis method was applied to ana-lyze the changes before and after the reform and compared with the national level of the same period.Results:After the implementa-tion of abolishing drug make-up, the growth of medical service quantity in the sample regions increased, which was higher than the na-tional average level, the increase of hospitalization service volume was greater than the increase of outpatient emergency service quanti-ty. Both the two indicators for usage efficiency of bed usage in estimation institutions changed from decreasing to improving after thereform. The decreasing speed of average outpatient emergency visit for each employee increased, the average hospitalization stay foreach employee improved the increase.Conclusion and Suggestion:The policy of abolishing drug make-up achieved good effects onboth service quantity and service efficiency, especially on inpatient service. Combined with reasonable performance evaluation methodand income allocation system, the reform of abolishing drug make-up could both increase the income of hospital and the income ofmedical staffs.

关 键 词：以药补医 医药分开 服务量 服务效率 

分 类 号：R197.3[医药卫生—卫生事业管理]