北京市医药分开和医耗联动综合改革对基层医疗机构门诊费用的影响  

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

作　　者：梁娟娟 蔡媛青 曹馨彤 和宇航 何绍斌 王文娟[1] LIANG Juanjuan(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16-21,33,共7页Medicine and Society

基　　金：国家社会科学基金资助项目,编号为22CGL052;中央财经大学政府管理学院研究生科研创新基金资助项目,编号为202211Y05;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基层医疗机构门诊费用的影响,为基层医疗机构管理和分级诊疗推进提供参考。方法:采用间断时间序列模型,选取北京市医保局2015年1月-2021年5月974家医疗机构74998条数据,分析两轮改革前后门诊及明细费用趋势变化和费用占比变化情况。结果:改革后,基层医疗机构次均门诊总费用在两轮改革后共增长56.23元,在医耗联动改革后每月下降1.93元,各类明细费用变化方向各有不同且幅度较小,但变化方向基本符合预期。药费在医耗联动改革后每月下降5.11元,药占比较大,经改革减少1.67%,但仍高达78.27%。材料费在两轮改革中分别瞬时减少1.76元和0.94元,但医耗联动后有上升趋势,耗占比改革后减少0.39%。手术治疗费在医耗联动改革后每月增加1.82元,其占比改革后增加1.19%。检查化验费在医耗联动改革后每月增加0.79元,其占比改革后增加0.43%。结论:经两轮改革,基层门诊总人次和总费用增加,费用内部结构优化不足。建议提升基层医疗机构技术服务水平,引导合理用药,提高基层医生收入,继续控制检查化验费,探索手术技术优化路径。Objective:To study the effect of the comprehensive reform of medical-pharmaceutical separation and medicine-consumables linkage on the outpatient expenses of grassroots medical institutions in Beijing,so as to provide reference for the management of grassroots medical institutions and the promotion of hierarchical diagnosis and treatment.Methods:Using the interrupted time series model,74998 data of 974 medical institutions in Beijing Medical Insurance Bureau from January 2015 to May 2021 were selected to analyze the trend changes and cost proportion changes of outpatient and detail expenses before and after the reform.Results:After the reform the average outpatient total costs increased in grassroots medical institutions but there was a long-term downward trend.Total per capita outpatient costs in grassroots medical institutions increased by a total of 56.23 yuan after the two reforms and decreased by 1.93 yuan per month after the reform of the medicine-consumable linkage.The direction of change in the breakdown of costs varied and was small,but was generally in line with expectations.The drug cost had dropped by 5.11 yuan per month after the medicine-consumable linkage reforms and the proportion of drugs was relatively large.After the reform it decreased by 1.67%but it was still as high as 78.27%.The cost of materials were instantaneously reduced by 1.76 yuan and 0.94 yuan after the two rounds of reforms,but there was an upward trend after medicine-consumables linkage and the proportion of consumption decreased by 0.39%after the reform.The cost of surgical treatment increased by 1.82 yuan per month after the medicine-consumable linkage reform and its proportion has increased by 1.19%.The cost of inspection and testing increased by 0.79 yuan per month after the medicine-consumable linkage reform and its proportion had increased by 0.43%after the reform.Conclusion:After two rounds of reform,the total number of grassroots outpatient visits and total costs increased,and the internal structure was not optimized.It is

关 键 词：医药分开 医耗联动 门诊费用 基层医疗机构 北京 

分 类 号：R197.3[医药卫生—卫生事业管理]