北京市医药分开综合改革下参保人群门诊经济负担研究  

Research on the impact of the clinic-pharmacy separation reform in Beijing on the economic burden of insured outpatients

作　　者：李春厚 杨丽 冯雅慧 叶媛 刘远立[1] Li Chunhou;Yang Li;Feng Yahui;Ye Yuan;Liu Yuanli(School of Public Health,Peking Union Medical College,Beijing 100005,China;Institute of Medical Information,Chinese Academy of Medical Sciences,Health and Medical Security Research Center,Beijing 100020,China)

机构地区：[1]北京协和医学院公共卫生学院,100005 [2]中国医学科学院医学信息研究所健康与医疗保障研究中心,北京100020

出　　处：《中华医院管理杂志》2020年第3期188-192,共5页Chinese Journal of Hospital Administration

摘　　要：目的探讨北京市医药分开综合改革对参保患者门诊就诊经济负担的影响。方法采用间断时间序列数据的分段回归模型,以北京市某三级甲等医院数据为例,分析2017年4月至2019年5月门诊服务人次、次均费用、个人负担在医药分开综合改革前后的变化情况。结果分段回归结果显示,医药分开综合改革当月,门诊患者个人负担率下降了5.20个百分点;从长远趋势看,患者个人负担的门诊药品费用由改革前平均每月上升0.24元转变为改革后平均每月下降0.50元(P<0.01),手术治疗费、检查化验费、材料费由平均每月上升0.14元、0.64元和0.36元转变为每月上升0.15元、0.70元和0.17元(P<0.01);同时,改革后门诊服务人次增长速度放缓,由改革前每月增加855人次变为改革后每月增加523人次。结论医药分开综合改革使得参保患者门诊就诊经济负担有所减轻。Objective To explore the impact of the clinic-pharmacy separation reform in Beijing on the outpatients with medical insurance.Methods A segmented regression model of interrupted time series(ITS)data was used,to analyze the changes from April 2017 to May 2019 in outpatient visits,average cost per visit,out-of-pocket burden,with a tertiary hospital in Beijing as an example before and after the reform.Results Segmental regression analysis showed that since the reform,the out-of-pocket burden of outpatients fell by 5.2%in the first month.After the reform,the medicine expenses decreased 0.50 yuan monthly instead of increasing 0.24 yuan before,and the surgery expenses,examination and laboratory fees,and materials expenses have increased from an average monthly increase of 0.14 yuan,0.64 yuan and 0.36 yuan to 0.15 yuan,0.70 yuan and 0.17 yuan respectively.Meanwhile,the growth rate of outpatient services slowed down,with an increase number dropping from 855 visits/month to 523 visits/month.Conclusions The reform had reduced the out-of-pocket expenses of outpatients.

关 键 词：医药分开 门诊费用 间断时间序列回归 经济负担 

分 类 号：R197[医药卫生—卫生事业管理]