医药分开改革的政策效果——基于医疗保险报销数据的经验分析  

Effects of Separating Treatment and Drug Sales:Evidence from Medical Insurance Claims Data

作　　者：陈醉[1] 宋泽 张川川[3] CHEN Zui;SONG Ze;ZHANG Chuanchuan(School of Finance and Statistics,Hunan University;School of Economics,Nankai University;School of Economics,.Central University of Finance and Economics)

机构地区：[1]湖南大学金融与统计学院,湖南长沙410006 [2]南开大学经济学院,天津300071 [3]中央财经大学经济学院,北京100081

出　　处：《金融研究》2018年第10期72-88,共17页Journal of Financial Research

基　　金：国家自然科学基金(批准号:71503282);霍英东高等院校青年教师基金的资助

摘　　要：2015年开始,按照国务院对公立医院改革的政策要求,公立医院改革试点城市全部取消药品加成,实施医药分开改革。本文基于某省会城市医疗保险报销数据,采用双重差分模型,估计了医药分开改革对医疗费用支出水平和支出结构的影响,为评估医药分开改革的政策效果提供了及时的和严谨的经验证据。实证分析显示,从支出水平看,医药分开改革使患者住院费用总支出显著增加了4. 9%,但是由于病人自付比例同时出现了显著下降,自付金额没有显著地上涨;从支出结构看,医药分开改革使患者药费支出显著下降了9. 5%,但是护理费和治疗费支出显著增加了69. 7%和53. 4%。医药分开改革还导致患者在短时期内的就诊次数出现了显著增加。总结而言,公立医院医药分开改革改善了公立医院收入结构,但是没有起到降低医疗费用支出的效果,也没有显著降低病人医疗成本负担。As a requirement of the public hospital reform initiated by the State Council in 2015,public hospitals in pilot cities should remove the markup on drug sales,and separate treatment and drug sales.Using medical insurance claims data from 2013 to 2015 for enrollees in the Urban Employee Basic Medical Insurance in one of China’s provincial capital cities,this paper examines the impact of separating treatment and drug sales reform on inpatient spending.The results show that the reform increases the inpatient spending by 4.9 percent,but has no statistically significant effects on out-of-pocket spending,which corresponds with a significant increase in the reimbursement rate.In addition,the reform substantially reduces the spending on drugs by 9.5 percent,but increases the spending on caring and diagnoses service by 69.7 and 53.4 percent,respectively.Moreover,the results show that the reform also leads to an increase in the frequency of inpatient visits in a given time period.In sum,the reform improves the composition of hospital revenue,but fails to reduce total inpatient spending and the out-of-pocket spending.

关 键 词：公立医院改革 医药分开 住院支出 

分 类 号：D04[政治法律—政治学] H51[语言文字]