浙江省推进县级公立医院药品零加成改革的实践与思考  

Insights of drug zero-profit reform at county-level public hospitals in Zhejiang Province

作　　者：李显文[1] 王桢[2] 徐飞鸿[2] 郑燕娜 

机构地区：[1]浙江医学高等专科学校,杭州310053 [2]浙江省卫生厅医政处 [3]杭州市卫生信息中心

出　　处：《中华医院管理杂志》2013年第6期404-407,共4页Chinese Journal of Hospital Administration

摘　　要：介绍浙江省推进药品零差率改革的做法。对试点县医院在改革前后的医院经济运行、患者医药费用负担、财政补助和医保基金支出等情况进行对比分析。改革取得了预期的成效，主要体现在：医疗服务量、医疗收入、财政补助等大幅增长，药品收入所占比例下降，医疗收入结构发生变化；患者门诊和住院平均费用增长得到控制，药品费用下降显著；医保基金支出虽增加但运行基本平稳；医保补偿比例提高，患者自负费用与县外就医比例均下降。同时也指出仍存在医疗服务价格调整不到位、财政补偿机制不够明确并缺乏可持续性、配套措施不够完善等问题。建议进一步加快支付制度改革，科学、动态调整医疗服务价格，明确财政补偿办法，优化医院内部管理，加快形成能够调动医务人员工作积极性的收入分配新机制。This paper presented the practice of Zhejiang in introducing the drug zero-profit reform. A comparative analysis was made to the pilot county hospitals regarding their business performance, patients＇ burden, financial subsidy and medical insurance expenditure. The reform has scored a success as expected with the following outcomes：sharp rise in medical services volume, medical income and financial aid on one hand; drop of the proportion of drug income and changes in the medical income makeup; controlled increase of average cost of outpatient and inpatient care, and significant drop of pharmaceutical costs; increased expenditure yet stable operation of medical insurance funds; proportional increase of medical insurance compensation, with drops of the proportion of both out-of- pocket expenses and visits to doctors out of their county. This reform, however, has such shortcomings as follows：insufficient adjustment toward true costs of medical services, lack of a clear and sustainable financial compensation mechanism,and that of supporting measures. Based on these, the authors call for accelerated payment system reform, dynamic and scientific adjustment of medical service prices, exploration of clear financial compensation methods, optimization of internal management of hospitals, and acceleration of the formation of a medical staff income distribution mechanism.

关 键 词：县级公立医院改革 药品零加成 实践与思考 

分 类 号：R197[医药卫生—卫生事业管理] R9[医药卫生—公共卫生与预防医学]