北京市医药分开和医耗联动综合改革对医院门诊费用的影响  

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

作　　者：胡洋溢 梁娟娟 蔡媛青 曹馨彤 何绍斌 王文娟[1] HU Yangyi(School of Government,Central University of Finance and Economics,Beijing,100081,China)

机构地区：[1]中央财经大学政府管理学院,北京100081 [2]中国社会科学院中国社会科学评价研究院,北京100732

出　　处：《医学与社会》2023年第8期9-15,共7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二、三级医院门诊费用的影响,为公立医院改革提供参考。方法:选取北京市2015年1月-2021年5月241家医院18557条数据,采用间断时间序列模型,分析改革前后次均门诊总费用、费用结构水平和趋势变化。结果:二级医院次均总费用在医药分开改革后瞬时减少,而三级医院次均总费用控费效果并不显著。二、三级医院药费及其占比在医药分开改革后短期和长期均显著下降,占比分别降低12.98%和15.26%;二、三级医院手术费及其占比在医药分开改革后短期和医耗联动改革后长期显著上升,占比分别增加3.17%和2.06%;二、三级医院材料费以及占比在医药分开改革后长期显著下降并在医耗联动改革后短期显著下降。结论:总费用政策效果显著,次均总费用难以降低;费用结构部分优化,药费及药占比控制效果显著,耗材费及耗占比长期政策效果不佳,手术费及其占比有所提升。建议推进二、三级医院联动改革,提升医疗系统整体效益,进一步深化改革措施。Objective:To study the effect of the comprehensive reform of medical-pharmaceutical separation and medicine-consumables linkage on outpatient expenses of secondary and tertiary hospitals in Beijing,so as to provide reference for the reform of public hospitals.Methods:A total of 18557 data from 241 hospitals in Beijing from January 2015 to May 2021 were selected,and the interrupted time series(ITS)model was used to analyze the level and trend of total outpatient expenses and expenses structure before and after the reform.Results:After the reform,the average outpatient total expenses in secondary hospitals decreased instantaneously after the reform of medical-pharmaceutical separation,while the control effect of the average outpatient total expenses in tertiary hospitals was not significant.The average outpatient drug expenses and their proportions in secondary and tertiary hospitals decreased significantly in the short and long term after the reform of medical-pharmaceutical separation,the proportion decreased by 12.98%and 15.26%respectively.Surgical expenses and their proportions in secondary and tertiary hospitals increased significantly in the short term after the reform of medical-pharmaceutical separation and in the long term after the reform of medicine-consumables linkage,accounting for 3.17%and 2.06%respectively.The material expenses and their proportions in secondary and tertiary hospitals decreased significantly in the long term after the reform of medical-pharmaceutical separation and in the short term after the reform of medicine-consumables linkage.Conclusion:The policy effect on total costs is significant,but it is difficult to reduce the average total costs.The expense structure has been partially optimized.The control effect on medication costs and the proportion of medication is significant.The long-term policy effect on consumable costs and the proportion of consumables is not good.The surgical treatment costs and its proportion have increased.It is recommended to promote the linkage reform of se

关 键 词：医药分开 医耗联动 门诊费用 北京 

分 类 号：R197.3[医药卫生—卫生事业管理]