城市公立医院药品零差率及补偿机制的实证研究  

Empirical Study on the Zero-profit Drug Policy and Compensation Mechanism in Urban Public Hospitals

作　　者：郜佳 陈丹镝[1] 崔欢欢[1] 江莉[1] 周亚旭[2] 

机构地区：[1]四川大学华西公共卫生学院,成都610041 [2]华中科技大学同济医学院医药卫生管理学院,武汉430030

出　　处：《中国药房》2017年第31期4341-4345,共5页China Pharmacy

基　　金：成都市发展与改革委员会资助课题(No.H161113)

摘　　要：目的:为城市公立医院药品零差率政策及补偿机制的更好实施提供参考。方法:以某市城市公立医院为例,通过对药品零差率政策实施下取消的药品加成费用、调整的医疗服务价格数据进行分析,考察药品零差率政策对医院、患者、医保基金以及实施前药占比不同的单病种[白内障(药占比2.94%)vs.慢性肾功能衰竭(药占比38.77%)]的影响。结果:实行药品零差率政策后,该市公立医院的整体补偿率为95.20%;城镇职工医保患者整体负担降低,次均负担费用降低了197.73元/次,城乡居民医保患者整体负担略有增加,次均负担费用增加了17.39元/次,但全部患者的整体负担有所降低。医保基金负担整体降低,其中城镇职工医保基金降低了15 118.55万元,城乡居民医保基金负担降低了455.04万元。在城镇职工医保和城乡居民医保两种医保方式下进行白内障治疗,医院收入分别增加了7.00%、8.99%,医保基金负担分别增加了12.07%、13.67%,患者负担分别增加了0.58%、3.43%;在两种医保方式下进行慢性肾功能衰竭治疗,医院收入分别降低了3.23%、3.93%,医保基金负担分别降低了3.19%、3.96%,患者负担分别降低了4.27%、3.63%。结论:药品零差率政策是我国目前破除"以药养医"机制较理想的措施,但在实施过程中需结合医院实际情况和不同病种,探讨医疗服务价格的调整方式、财政合理的补偿措施和医保付费机制。OBJECTIVE：To provide reference for developing zero-profit drug policy and compensation mechanism better in urban public hospitals. METHODS：Taking a public hospital in a city as an example,effects of zero-profit drug policy on hospitals,patients,health insurance fund and single diseases with different drug proportions [cataract（2.94%） vs. chronic renal failure（38.77%）] were investigated by analyzing the canceled drug addition costs and adjusted medical service price data after developing zero-profit drug policy. RESULTS：After developing zero-profit drug policy,the overall compensation rate in the public hospital was 95.20%. The overall burden of urban patients was reduced,average burden cost was decreased 197.73 yuan every time;while the overall burden of urban and rural residents had increased,average burden cost was increased 17.39 yuan every time;and the overall burden of all patients had decreased. Health insurance fund had decreased,in which,the urban workers were decreased151 185 500 yuan,and urban and rural residents were increased 4 550 400 yuan. In medical insurance for urban workers and health insurance for urban and rural residents,hospital increased by 7.00% and 8.99% in income in the treatment of cataract,the medical insurance fund increased by 12.07% and 13.67%,and patients＇ burden increased by 0.58% and 3.43%,respectively. For chronic renal failure,hospital income increased by 3.23% and 3.93%,medical insurance fund decreased by 3.19% and 3.96%,and patients＇ burden decreased by 4.27% and 3.63%,respectively. CONCLUSIONS：Zero-profit drug policy is the ideal measure for getting rid of＂drug-maintaining-medicine＂. When developing the policy,it should be combined with actual situation and different diseases to explore adjustment of medical service prices,reasonable financial compensation models and medical insurance payment mechanism.

关 键 词：城市公立医院 药品零差率政策 补偿机制 患者 医保基金 

分 类 号：R95[医药卫生—药学]