中国公立医院药品零差率政策实施效果的Meta分析  

Effect of Implementation of the Zero Markup Medicines Policy in Chinese Public Hospitals: A Meta-analysis

作　　者：程汉超 张羽欧 孙静[1] 刘远立[1] Cheng Hanchao;Zhang Yuou;Sun Jing;Liu Yuanli(School of Health Policy and Management,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100710,China)

机构地区：[1]中国医学科学院北京协和医学院卫生健康管理政策学院,北京100710

出　　处：《药物流行病学杂志》2021年第9期601-610,共10页Chinese Journal of Pharmacoepidemiology

摘　　要：目的:系统评价药品零差率政策在我国公立医院的实施效果,包括对费用水平、服务量和医疗机构运行的影响,为进一步优化和落实政策目标提供更高级别的参考证据。方法:计算机系统检索CNKI、WanFang Data、VIP、SinoMed、Web of Science、PubMed和Embase数据库,搜集采用统计推断方法的有关我国公立医院药品零差率政策实施效果评价的研究,检索时限均从建库至2021年2月7日。由2位研究人员独立筛选文献、提取研究信息、评价偏倚风险后,使用RevMan 5.4软件进行Meta分析。结果:共纳入15项非随机准实验干预性研究。Meta分析结果显示,政策实施后,月度住院次均费用短期内下降830元[WMD=-0.83,95%CI(-1.44,-0.21),P=0.008,单位:千元];陕西省县医院非手术病种年度住院次均费用下降360元[WMD=-0.36,95%CI(-0.62,-0.10),P=0.006,单位:千元];北京市三甲医院住院次均费用年均下降6%[WMD=-0.06,95%CI(-0.10,-0.02),P=0.004]。次均药品费用均下降:北京市二、三级医院月度门诊下降24.86元[WMD=-24.86,95%CI(-28.45,-21.28),P<0.001]、慢性非传染性疾病月度住院下降1 160元[WMD=-1.16,95%CI(-1.51,-0.80),P<0.001,单位:千元]、县级医院非手术病种年度住院下降240元[WMD=-0.24,95%CI(-0.39,-0.09),P=0.002,单位:千元]。北京市三级医院月度住院次均药品费用占比下降5%[WMD=-0.05,95%CI(-0.08,-0.02),P=0.003]。北京市三级医院月度住院次均耗材费用占比上升1%[WMD=0.01,95%CI(0.002,0.03),P=0.02]。北京市二、三级医院月度门诊次均检验检查费用下降2.97元[WMD=-2.97,95%CI(-5.88,-0.06),P=0.05]。全国县级医院住院人次数年均下降4%[WMD=-0.04,95%CI(-0.05,-0.02),P<0.001]。结论:药品零差率政策在降低公立医院次均药品费用及次均药品费用占比方面取得了成效,但由于药品零差率和上调体现医护人员劳动价值的医疗服务价格,而导致药品收入减少高于医疗服务收入上涨,医院收入减少。要实现�Objective:To systematically evaluate the implementation effect of zero markup medicines policy in Chinese public hospitals, including its impact on expenditure, service volume and institutional performance, in order to generate higher level of evidence for optimization and well implementation of the policy. Methods:Systematically searched multiple databases, including CNKI, Wanfang Data, VIP, SinoMed, Web of Science, PubMed and Embase, and extracted the published evaluations of the effect of implementing the zero markup medicines policy in public hospitals in China with statistical inference. The retrieval time was from the establishment of the database to February 7, 2021. Two researchers independently screened the literature, extracted information and evaluated the risk of bias of the study. RevMan5.4 software was used to perform the Meta-analysis. Results:A total of 15 non-randomized quasi-experimental studies were included in the Meta-analysis. The results of Meta-analysis showed that, after the implementation of the policy, the monthly expense per hospitalization decreased by 830 yuan(WMD=-0.83,95%CI-1.44 to-0.21, P=0.008, unit: 1 000 yuan);the annual expense per hospitalization of non-surgical diseases in county hospitals of Shaanxi province decreased by 360 yuan(WMD=-0.36, 95%CI-0.62 to-0.10, P=0.006, unit: 1 000 yuan);the expense per hospitalization of tertiary hospitals in Beijing decreased annually by 6%(WMD=-0.06, 95%CI-0.10 to-0.02, P=0.004). The medicines expenses decreased [monthly per outpatient in second or third level hospitals in Beijing: 24.86 yuan(WMD=-24.86, 95%CI-28.45 to-21.28, P<0.001, unit: 1 000 yuan);monthly per hospitalization for chronic diseases: 1 160 yuan(WMD=-1.16, 95%CI-1.51 to-0.80, P<0.001, unit: 1 000 yuan);annual per hospitalization for non-surgical diseases in county hospitals: 240 yuan(WMD=-0.24, 95%CI-0.39 to-0.89, P=0.002, unit: 1 000 yuan)]. The monthly proportionate medicines expense per hospitalization in tertiary hospitals in Beijing:-5%(WMD=-0.05, 95%CI-0.08 to-0.02,

关 键 词：公立医院 药品零差率政策 实施效果 费用水平 服务量 机构运行 META分析 

分 类 号：F407.7[经济管理—产业经济]