北京市某精神专科医院两项综合改革及新冠病毒感染疫情前后医疗费用比较  

Comparison of Medical Expenses in a Psychiatric Hospital in Beijing Before and After Two Comprehensive Reforms and COVID-19 Epidemic

作　　者：王冰倩 李秀华[2] WANG Bingqian(Operation Management Office,Peking University Sixth Hospital,Beijing,100191,China)

机构地区：[1]北京大学第六医院运营管理办公室,北京100191 [2]北京大学第六医院计财处,北京100191

出　　处：《医学与社会》2023年第6期80-86,共7页Medicine and Society

基　　金：中国卫生经济学会第二十一批重点招标课题,编号为CHEA2021040103;北京大学医学部项目“北京市医药分开及医耗联动综合改革对精神专科医院运营的影响探析”,编号为201901。

摘　　要：目的:比较分析医药分开与医耗联动综合改革及新冠病毒感染疫情前后,北京市精神专科医院医疗费用的变化情况,为改革的深入开展和完善提供参考。方法:选取北京某精神专科医院2016年1月至2021年8月数据,利用间断时间序列的分段回归模型,分析两轮改革及疫情对医疗费用水平和结构的影响。结果:经过两轮改革,门诊和住院次均药品费用占比分别下降13.86%和4.65%、医疗服务费用占比分别上升8.74%和21.46%,但自疫情发生以来,呈相反方向变化。间断时间序列结果显示,医药分开改革后,次均药品费用瞬间显著下降并形成持续下降趋势,医疗服务费用瞬间显著上涨但未形成持续增长趋势,而检查化验费用在医耗联动改革后保持长期的下降趋势,符合改革导向。疫情发生以来,部分医疗费用结构性增长。结论:两轮改革的实施使得精神专科医院费用结构不断优化,但疫情对正常诊疗造成重创,使得改革对费用结构长期的利好调整趋势发生扭转。建议相关部门共同施策、形成合力,推进精神卫生事业稳步发展。Objective:To compare and analyze the changes on the medical expenses of psychiatric hospitals in Beijing before and after the comprehensive reform of medical separation and medical consumption linkage,and the COVID-19 epidemic,so as to provide a reference for the further development and improvement of the reform.Methods:Data from a psychiatric hospital in Beijing from January 2016 to August 2021 were selected to analyze the impact of the two rounds of reform and the epidemic on the level and structure of medical costs using a segmented regression model with interrupted time series.Results:After the two rounds of reform,the percentages of outpatient and inpatient per-visit drug costs decreased by 13.86%and 4.65%,respectively,while the percentages of medical service costs increased by 8.74%and 21.46%,respectively.However,since the onset of the epidemic,these trends had reversed.The results of the intermittent time series demonstrated that,after the medical separation reform,the sub-average drug costs instantly dropped significantly and formed a sustained downward trend,medical service costs instantly rose significantly but did not form a sustained increasing trend,while examination and laboratory costs maintained a long-term downward trend after the medical consumption linkage reform,in line with the reform orientation.Certain medical expenses had escalated structurally since the outbreak of the epidemic.Conclusion:The implementation of the two rounds of reform has led to a continuous optimization of the cost structure of psychiatric hospitals,but the epidemic has hit normal treatment hard,reversing the long-term trend of favorable adjustment to the cost structure by the reform.It is recommended that relevant departments collaborate to put policies into effect and form synergies to promote the steady development of mental health.

关 键 词：医疗费用 医药分开 医耗联动 新冠病毒感染疫情 精神专科医院 

分 类 号：R197.1[医药卫生—卫生事业管理]