北京市医药分开综合改革前后公立医院医保患者医疗费用结构变化分析  

Influence of separating medical treatment and drug sales reform on changes of medical expenses structure in patients covered by basic healthcare insurance

作　　者：刘微[1] 庄倩 LIU Wei;ZHUANG Qian(Institute of Hospital Administration,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院医院管理研究所

出　　处：《解放军医学院学报》2019年第6期600-604,共5页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨北京市医药分开综合改革即设立医事服务费、规范调整医疗服务价格等改革举措对三级医院医保患者医疗费用结构的影响。方法对北京市某三甲综合性医院医药分开综合改革前后一年医保病人的费用进行回顾性对比研究,在描述性统计分析的基础上,采用结构变动值、结构变动度和结构变动贡献率等指标研究医疗费用结构的变化。结果医药分开综合改革实施后,该医院医保患者的门急诊量下降1.11%,住院量及手术量分别增长4.78%和3.43%,平均住院时间减少0.2 d;药占比下降5.41%,检查费占比下降1.23%,体现医务人员技术劳务价值的费用占比增长7.35%;费用结构变动中药品费、诊察费、材料费、检查费和治疗费累积贡献率达90.67%;医保次均门诊费用、次均住院费用有一定程度的增长。结论三级医院的住院服务功能得到强化,医保患者医疗费用结构趋于合理,药占比明显降低,医务人员劳务价值逐渐体现。处方分解可能导致医事服务费增长,增加门诊患者费用负担。材料费占比依然偏高,化验费增长迅速,医院需引起重视。Objective To explore the impact of separating medical treatment and drug sales reform on the structural changes of medical expenses for basic healthcare insurance covered patients in a tertiary hospital.Methods A retrospective comparative study was conducted on the cost of basic healthcare insurance covered patients before and after the medical reform in a tertiary hospital in Beijing.Based on descriptive statistical analysis,index of structural change value,degree of structure variation and structural contribution rate were calculated to investigate the structural changes in medical costs.Results After medical reform,the outpatient(emergency)volume of basic healthcare insurance covered patients in this hospital dropped by 1.11%,while the hospitalization and surgical volume increased by 4.78% and 3.43% respectively,and the average hospitalization days decreased 0.28 days.The percent of medical expense for prescription drugs decreased by 5.41%,inspection fees decreased by 1.23%,labor cost reflecting the value of medical staff’s services increased by 7.35%.The cost of drug,medical examination,consumptive material,inspection and treatment accounted for 90.67% of the total cost change.The average medical cost per visit for outpatient and the average cost per hospital stay for inpatient both increased to some extent.Conclusion After reform,the medical service for inpatient in the tertiary hospitals is strengthened,the medical cost structure of patients with basic healthcare insurance tends to be reasonable,the proportion of drug revenue reduces significantly and the labor value of medical staffs is emphasized.The time or dosage limits on the prescribing may lead to an increase in medical service fees which will bring a heavier burden to outpatients.Since the ratio of consumptive material cost to total cost is still high,and the laboratory test cost has grown rapidly,close attention should be paid to them.

关 键 词：医药分开 医疗费用 费用结构 卫生经济 公立医院 

分 类 号：R197.3[医药卫生—卫生事业管理]