北京市医药分开和医耗联动综合改革对医院住院费用的影响  

Effect of Comprehensive Reform of Medical-pharmaceutical Separation and Medicine-consumables Linkage on Hospital Hospitalization Expenses in Beijing

作　　者：蔡媛青 胡洋溢 樊荣 欧阳雁玲[4] 琚理 王文娟[2] CAI Yuanqing(Chinese Academy of Social Sciences Evaluation Studies,Beijing,100732,China)

机构地区：[1]中国社会科学院中国社会科学评价研究院,北京100732 [2]中央财经大学政府管理学院,北京100081 [3]北京大学肿瘤医院,北京100142 [4]国家开放大学农林医药教学部医药学院,北京100039

出　　处：《医学与社会》2023年第8期1-8,共8页Medicine and Society

基　　金：国家社会科学基金资助项目,编号为22CGL052;国家自然科学基金资助项目,编号为71473284;中国社会科学院青年人文社会科学研究中心社会调研项目。

摘　　要：目的:研究北京市医药分开和医耗联动综合改革对于北京市各级医院住院费用的影响,评估两轮改革的阶段性成果,为下一阶段深化改革提供参考。方法:采用间断时间序列模型,选取北京市2016-2020年521家医院数据,分析改革前后各级医院住院总费用及各明细费用趋势变化。结果:两轮改革后,三级、二级与基层医院例均住院总费用增幅分别为17.92%、33.92%和65.46%,改革后三级医院和基层医院总费用呈现下降趋势,而二级医院总费用继续增长且增速提高。改革后,各级医院药占比均大幅下降,医疗费用占比均增加,但两轮改革对各级医院耗占比的优化效果有限。结论:两轮改革后,住院费用结构持续优化,费用增长控制力度仍需加大,药品费用改革效果良好,费用结构优化仍需进一步优化,技术劳务价值显著提高,长期改革效果有待提升,耗材费用存在回升趋势,多个环节耗材治理仍需加强。各级医院改革效果不同,应深化分级诊疗制度建设。Objective:To study the effect of comprehensive reform of"medical-pharmaceutical separation"and"medicine-consumables linkage"on hospitalization expenses of hospitals at all levels in Beijing,and to evaluate the phased results of the two rounds of reform,so as to provide references for deepening the reform in the next stage.Methods:Based on the data of 521 hospitals in Beijing from 2016 to 2020,the interrupted time series model was used to analyze the changes of total hospitalization expenses and detailed expenses before and after the reform.Results:After the two rounds of reform,the total inpatient cost of tertiary,secondary and primary hospitals increased by 17.92%,33.92%and 65.46%,respectively.After the reform,the total cost of tertiary hospitals and primary hospitals showed a downward trend,while the total cost of secondary hospitals continued to increase and the growth rate increased.After the reform,the proportion of drugs in hospitals at all levels decreased significantly and the proportion of medical expenses increased,but the optimization effect of the two rounds of reform on the consumption ratio of hospitals at all levels was limited.Conclusion:After the two rounds of reform,the structure of hospitalization expenses has been continuously optimized,and the control of cost growth still needs to be strengthened.The reform of drug costs has achieved good results,and the cost structure still needs to be further optimized.The value of technical services has been significantly improved,and the long-term reform effect needs to be improved.The cost of consumables has a rising trend,and consumable management should be strengthened in multiple links.The reform effect of hospitals at all levels is different,and the construction of hierarchical diagnosis and treatment system should be deepened.

关 键 词：医药分开 医耗联动 住院费用 北京 

分 类 号：R197.3[医药卫生—卫生事业管理]