患者视角下医疗服务价格改革执行效果研究  

Study on the implementation effect of medical service price reform from the perspective of patients

作　　者：张颖[1] 段利忠[2] 周渝金 张崇旭[2] 卢奇[3] ZHANG Ying;DUAN Lizhong;ZHOU Yujin;ZHANG Chongxu;LU Qi(Department of Respiration,Beijing Jishuitan Hospital,Beijing 100096,China;College of Management,Beijing University of Chinese Medicine,Beijing 100029,China;College of Economics,Beijing Technology and Business University,Beijing 100048,China)

机构地区：[1]北京积水潭医院呼吸科,北京100096 [2]北京中医药大学管理学院,北京100029 [3]北京工商大学经济学院,北京100048

出　　处：《中国医药导报》2019年第29期179-184,188,共7页China Medical Herald

基　　金：卫生计生发展智库建设联盟课题

摘　　要：目的探究医疗服务价格改革效果及患者对就医费用评价的影响因素。方法2017年9月~2018年2月从京津冀鲁辽五地区分别抽取一所公立医院,共调查5家医院门诊及住院患者。采用文献分析法和专家访谈法设计医疗服务价格动态调整形成机制调查问卷,从个人基本特征、当前医疗服务价格政策现状、当前医疗服务价格政策执行效果3个维度进行改革效果分析。结果京津冀鲁辽五地区的医疗服务项目价格总评分为3.861分;患者对手术费和检查费评分比较高,分别为4.097分和4.011分;多重线性回归分析可得:年龄和是否拥有商业医疗保险影响患者对就医综合费用的评价(P<0.05);患者最近就诊医疗机构等级和是否还拥有商业医疗保险影响患者对改革后综合效果的评价(P<0.05)。不同性别和不同年龄关注医疗政策的方式分布,差异有统计学意义(P<0.05);在不同性别层次下,不同年龄分组的被调查者获取医疗服务价格改革政策途径的分布,差异有统计学意义(P<0.05)。结论医疗服务价格改革执行效果良好,但仍需拓宽医疗服务价格改革政策宣传,优化医疗服务项目价格结构,增大商业医疗保险参保覆盖面,以缓解患者医疗负担。Objective To explore the effect of medical service price reform and the factors that affect the patients′evaluation of medical expenses.Methods From September 2017 to February 2018,one public hospital was selected from the five regions of Beijing,Tianjin,Hebei,Shandong and Liaoning respectively,patients of five outpatients and inpatients were investigated.Literature analysis method and expert interview method were used to design questionnaires on the formation mechanism of dynamic adjustment of medical service prices.The reform effect of was analyzed based on the three dimensions such as characteristics of individuals,the status quo of the current medical service price policy and the implementation effect of the current medical service price policy.Results The total price of medical services in the five regions of Beijing,Tianjin,Hebei,Shandong and Liaoning was 3.861 points.Patients rated the cost of surgery and examination higher,they scored 4.097 and 4.011 respectively.Multiple linear regression analysis showed that age and whether the patient had commercial medical insurance affected the patient′s evaluation of comprehensive medical expenses(P<0.05).Patients′evaluation of the comprehensive effect after the reform was affected by the level of the medical institutions they visited recently and whether they still had commercial medical insurance(P<0.05).The different gender and age paid attention to the distribution of medical policy,and the difference was statistically significant(P<0.05).At different gender levels,there was a statistically significant difference in the distribution of access to medical service price reform policies for respondents of different age groups(P<0.05).Conclusion The implementation effect of medical service price reform is good,but it still needs to expand the publicity of medical service price reform policy,optimize the price structure of medical service items,and increase the coverage of commercial medical insurance to relieve the medical burden of patients.

关 键 词：医疗服务价格 改革效果 影响因素 商业医疗保险 

分 类 号：R197.1[医药卫生—卫生事业管理]