取消以药补医对县级医院病人就医负担的影响  

The Impact of Abolishing Drug Make-up on Patients' Economic Burden 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44-47,共4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病人就医负担的影响。方法:研究选择东、中、西部具有典型代表性且改革时间接近的三个地区共22所县级公立医院为研究对象,分析在改革前后这22所公立医院的病人就医负担的变化,并将各指标与全国同期水平比较。结果:改革后样本地区门急诊次均费用和每床日平均费用加速增长,增长速度远高于全国平均水平;门急诊次均费用药占比和每出院者平均医疗费用药占比减速下降,下降幅度大于全国水平。结论与建议:改革后,就医负担中的药占比快速下降,达到了取消以药补医最直接的目的;但在短期内,门急诊次均费用和每床日平均费用并没有得到有效控制。取消以药补医对病人就医负担的影响还需要深入的研究。Objective:To assess the effects on patients’ economic burden after conducting abolishing drug make-up policy incounty-level public hospitals in China.Methods: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 were chosen to analyze the changes ofmedical burdens for patients from the 22 public hospitals before and after the reform and the indicators were compared with the na-tional level of the same period.Results:After the reform, both the outpatient expenditure per visit and inpatient expenditure per bedstay had accelerated with a raising speed, which was higher than the national level; the percentage of drug expenditure in both outpa-tient per visit and inpatient per stay had decelerated with a dropping speed, which was larger than the national level.Conclusion and Suggestion:After the reform, the proportion of medical burden dropped quickly, which achieved the most direct objective of abolish-ing drug make-up policy; however, the average per capita outpatient emergency cost and average cost per bed for each day had notbeen effectively controlled in short term. The effects of abolishing drug make-up policy on the medical burden for patients still need-ed further analysis.

关 键 词：以药补医 医药分开 就医负担 

分 类 号：R197.3[医药卫生—卫生事业管理]