医生视角下北京市公立医疗机构价格改革执行效果研究  

Study on implementation effect of price reform in Beijng public medical institutions from the perspectives of doctors

作　　者：周渝金 张崇旭[1] 段利忠[1] 卢奇[2] ZHOU Yu-jin;ZHANG Chong-xu;DUAN Li-zhong;LU Qi(College of Management,Beijing University of Chinese Medicine,Beijing 100029,China;School of Economics,Beijing Technology and Business University,Beijing 100048,China)

机构地区：[1]北京中医药大学管理学院,北京100029 [2]北京工商大学经济学院,北京100048

出　　处：《卫生软科学》2020年第8期16-21,共6页Soft Science of Health

基　　金：卫生计生健康智库联盟2017年课题:医疗服务价格动态调整机制研究。

摘　　要：[目的]调查北京市实施医药分开综合改革一年后改革效果,探究各级公立医疗机构政策执行情况与存在的问题,为政策调整,实现政府、公立医疗机构、医保机构等利益合理分配提供参考。[方法]采用随机抽样方法对北京市不同等级不同公立医疗机构的593位医生进行问卷调查,对个人基本特征、改革后所在机构医疗服务价格的变化情况和效果评价、医生对当前医疗服务价格相关政策认知度与评价进行调查;对不同等级机构之间的6种费用变化和改革效果综合得分分别进行χ2检验和K-W检验,对不同等级机构之间医生对改革认知度进行χ2检验。[结果]不同等级公立医疗机构的住院费和治疗费的变化差异有统计学意义(P<0.05),三级医院医生中有36.7%和59.1%的人认为提高了住院费和治疗费,二级医院医生中有37.5%和54.5%的人认为提高了住院费和治疗费,一级医院医生中有25.2%和41.1%的人认为提高了住院费和医疗费;主要的6种医疗费用中,56.6%的医生认为提高了诊查费,54.2%的医生认为提高了检查费,52.7%的医生认为提高了手术费;43.8%的医生认为降低了检验费,41.9%的医生认为降低了治疗费,35.2%的医生认为降低了住院费。[结论]改革后,各级医疗机构取得一定的综合成效,诊查费、检查费、手术费提高明显;医务人员劳务技术价值体现等方面效果明显,但收入上仍存在不合理。政府应当按照医院等级和类型调整补偿比例,促进医院健康发展;应该进一步改革医院收入分配制度,提高医生群体的合理收入;医保机构应当继续推行复合型支付方式,加强对医院的合作和监管。Objective To investigate comprehensive reform effect of carrying out the separation of medical treatment and drug sales after one year in Beijing,explore policies implementation situation and existing problems in public medical institutions at all levels,so as to provide reference for policy adjustment and realize reasonable distribution of interests among the government,public medical institutions and medical insurance institutions.Methods Questionnaire surveys were conducted among 593 doctors in different level and different public medical institutions in Beijing by random sampling method.It surveyed basic characteristics of individuals,changes and effect evaluation of medical service price in these institutions after the reform,doctors awareness and evaluation about the changes of current medical service price and relevant policies.c2 and K-W test were conducted in 6 types fee change and comprehensive score of reform effect in different level public medical institutions,and c2 test was conducted in doctors cognition degree in different level public medical institutions.Results There was statistically significant in change difference of hospitalization,treatment and diagnostic expenses in different level public medical institutions(P<0.05).There were 36.7%and 59.1%doctors thought that hospitalization,treatment and diagnostic expenses were increased in tertiary hospitals,37.5%and 54.5%doctors thought so in second-class hospitals,and 25.2%and 41.1%doctors thought so in first-class hospitals.In 6 main types of medical expenses,56.6%doctors thought that diagnostic expenses were increased,54.2%doctors thought that examination fee was increased,52.7%doctors thought that operation fee was increased,43.8%doctors thought that test fee was reduced,41.9%doctors thought that treatment and diagnostic expenses were reduced,35.2%doctors thought that hospitalization fee was reduced.Conclusions After the reform,the medical institutions at all levels have achieved a certain comprehensive effects.Diagnosis,examination and operati

关 键 词：医药分开 公立医院 改革效果 北京市 

分 类 号：R197[医药卫生—卫生事业管理]