“药品零加成”政策能否缓解患者负担?——基于中部某省公立医院试点的效果评估  

Can the“Zero Markup Drug”Policy Alleviate the Burden of Patients?Based on the Effect Evaluation of a Pilot Public Hospital in a Province of Central China

作　　者：李静[1] 虞燕君 彭飞[1] 路伟 Li Jing;Yu Yanjun;Peng Fei;Lu Wei(School of Economics,Hefei University of Technology,Hefei 230601,China;School of Management,Hainan Medical University,Haikou 571199,China)

机构地区：[1]合肥工业大学经济学院,安徽合肥230601 [2]海南医学院管理学院,海南海口571199

出　　处：《财经研究》2021年第12期49-63,共15页Journal of Finance and Economics

基　　金：国家自然科学基金项目(71974051);国家社会科学基金重大项目(18ZDA064);中央高校基本科研业务费专项资金项目(JZ2021HGTB0067)。

摘　　要："药品零加成"政策是新时期进一步推广深化医药卫生体制改革的重要政策。文章基于2013-2019年我国中部某省医疗机构的诊疗服务和财务统计数据,利用双重差分模型考察改革的政策效果和作用机制。研究发现,"药品零加成"政策的实施能显著降低试点公立医院的药品收入占比、患者自付费用以及患者单次诊疗费用,但材料费等却呈现一定的上涨趋势。政府直接补助、财政投资以及信贷支持的增加和药品采购成本的下降是"药品零加成"得以顺利实施的重要原因。多角度的稳健性检验证实了结论的稳健和可靠。文章进一步结合2014-2018年某公立三甲试点医院住院患者病案个体数据,延伸考察了"零加成"政策对不同人群的影响,结果再次证实了该政策确实能够缓解患者负担,特别是因病致贫问题。政策启示表明,应健全公立医院政府补贴和投资政策,强化绩效考核机制,完善收入监管,巩固"零加成"政策的成果和持续性。文章的研究为进一步深化医药卫生体制改革提供了参考和依据。Since the new medical and health reform,China has issued a series of policies and measures.Among them,the“Zero Markup Drug”policy is an important policy node for further promoting and deepening the medical and health reform in the new era.Based on the treatment service and financial statistical data of medical institutions in a province of central China from 2013 to 2019,the policy effect and mechanism of the reform are investigated using the DID method.This paper further studies the impact of“Zero Markup Drug”policy on different groups by combining the individual data of inpatients in a first-class pilot public hospital from 2014 to 2018.The results are as follows:Firstly,the implementation of“Zero Markup Drug”policy can significantly reduce the drug proportion in pilot public hospitals,and this effect is more significant in general hospitals.Secondly,from the perspective of patients,self-payment cost and single medical expenditures of patients have decreased significantly with the implementation of the policy.The profit-pursuing motive of pilot hospitals has been somewhat stemmed,but the cost of materials has shown a rising trend.Thirdly,the increase of direct government subsidies,financial investment and credit support,and the decline of drug purchase costs are the important reasons for the smooth implementation of“Zero Markup Drug”policy.Fourthly,combined with individual medical record data of inpatients,the extended study results once again confirm that the“Zero Markup Drug”policy can indeed alleviate the burden of patients,especially the problem of poverty caused by disease.The multi-level tests also confirm the robustness and reliability of the conclusion.This paper tries to make some contributions in the following aspects:Firstly,it studies the changes of the medical burden of patients from the perspective of“Zero Markup Drug”policy for the first time.Secondly,the micro data based on the hospital level cover a wide range and long periods,which can reflect the heterogeneity characte

关 键 词：医疗卫生综合改革 “药品零加成”政策 患者负担 双重差分模型 

分 类 号：F062.6[经济管理—政治经济学]