2005—2016年北京市公立医院医疗费用增长趋势及结构分析  

Analysis on the trend of medical expenditure and structure of changes from 2005 to 2016 in public hospitals of Beijing

作　　者：沈玉卿 魏田 王俊锋 杨莉[1] SHEN Yu-qing;WEI Tian;WANG Jun-feng;YANG Li(School of Public Health,Peking University,Beijing 100191,China)

机构地区：[1]北京大学公共卫生学院,北京100191

出　　处：《中国卫生资源》2018年第6期506-511,516,共7页Chinese Health Resources

基　　金：国家自然科学基金(71273016);北京市卫生和计划生育委员会基金资助项目(20160414)

摘　　要：目的分析2005—2016年北京市公立医院医疗费用的增长现状及影响因素。方法利用2005—2016年北京市卫生和计划生育统计资料,比较12年间北京市公立医院医疗费用的变化,并分析服务利用、价格、患者流动对全市、各区(县)公立医院医疗费用增长的作用。结果北京市公立医院医疗费用总额不断增长,2016年医疗费用总额是2005年的3.50倍,但2012年后增长率逐年下降,2016年增长率仅为6.7%。2005—2014年,就诊人次增加是全市费用增长的主要驱动因素;2014—2016年,次均费用增加是全市费用增长的主要驱动因素。具体到各区(县):次均费用增加是主城区费用增长的主要驱动因素;就诊人次增加是近郊区费用增长的主要驱动因素;对远郊区来说,次均费用增加是门诊收入增长的主要驱动因素,就诊人次增加开始成为住院收入增长的主要驱动因素。患者流动对医疗费用的作用小。结论北京市较高的门诊收入占比与二级、三级医疗机构定位不符。医疗机构间患者流动不足。服务利用是医疗费用增加的主要影响因素,但其作用在逐渐削弱。不同区域医疗机构发展水平不同,其费用增长模式也不同。Objective To analyze current status and influencing factors of the increase in medical expenditure in publichospitals of Beijing from 2005 to 2016. Methods Statistics of health and family planning in Beijing from 2005 to 2016 wereused,the changes in medical expenses were compared,and the effects of service utilization,prices,and patient flow onmedical cost of municipal and district hospitals were analyzed. Results Total medical expenses in Beijing continued to grow.Total medical expenses in 2016 were 3.50 times of that in 2005,but the growth rate declined year after year from 2012.The growth rate of medical expenses in 2016 was only 6.7%. For the whole city,the increase in the number of patient visitswas the main driving factor for the increase of medical expenses from 2005 to 2014,while the increase in average cost pervisit became the main driving factor during 2014 and 2016. For different districts,the increase in average cost per visit wasthe main driving factor for the medical costs increase in urban areas ;the increase in the number of patient visits was themain driving factor for the medical expenses increase in the suburbs ;for the rural areas,the increase in average cost pervisit was the main driving factor for the increase in outpatient expenses,while the increase in the number of patient visitswas the main driving factor for the increase in hospitalization costs. There was little effect of patient flow on medical costs.Conclusion Outpatient expenses of secondary and tertiary medical institutions account for a relatively high proportionin Beijing,which does not accord with the institution target. Patient flow among medical institutions is inadequate.Service utilization is the leading cause of the increase in medical expenses,yet its influence is gradually weakening. Thedevelopment level of medical institutions in various regions are different,hence their cost growth patterns also differ.

关 键 词：医疗费用 增长 服务价格 服务利用 患者流动 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R197.3