医疗服务价格改革实施后黄冈市三级公立医院住院费用结构的变动分析  

Analysis of the Changes in Inpatient Expenses Structure at Tertiary Public Hospitals in Huanggang City After the Implementation of Medical Service Price Reform

作　　者：王瑞 杨赐然[1,2] 吴若男 刘韵绪 毛宗福 崔丹[1,2] WANG Rui(School of Public Health,Wuhan University,Wuhan,Hubei,430071,China)

机构地区：[1]武汉大学公共卫生学院,湖北武汉430071 [2]武汉大学全球健康研究中心,湖北武汉430072

出　　处：《医学与社会》2024年第10期132-137,共6页Medicine and Society

基　　金：比尔及梅琳达·盖茨基金会“完善中国医保制度研究”项目,编号为OPP1199760。

摘　　要：目的:对湖北省黄冈市4次医疗服务价格改革后三级公立医院次均住院费用结构及其变化进行分析,为其推进改革试点工作提供参考。方法:从黄冈市医疗保障局获取历次医疗服务价格改革文件,从公立医院统计报表中获取2018-2022年住院人次及次均住院费用,运用结构变动度法和新灰色关联法分析住院费用构成及其影响因素的变化。结果:2018-2022年,三级公立医院次均住院费用增速波动较大;住院费用结构变动度为15.12%,其中,治疗费占比上升3.75%,药品费、卫生材料费占比分别下降3.38%、3.51%,三者对费用的结构变动贡献率累计为70.44%;医疗服务性收入占比增加3.99个百分点;药品费与次均费用的关联度为0.9092,仍然是影响住院费用的最主要因素。结论:黄冈市4次医疗服务价格改革实施后,药品费、卫生材料费用控制较好,医疗服务收入占比提高,住院费用结构不断优化,但仍然存在次均住院费用变动幅度大、护理费占比过低的问题。应做好价格改革与配套支付方式改革的衔接,持续落实药品耗材集中采购政策,并相应提高护理类医疗服务项目价格。Objective:To analyze the structure and changes of the average hospitalization expenses of tertiary public hospitals after the four medical service price reforms in Huanggang of Hubei province,so as to provide a reference for promoting the reform pilot work.Methods:The research involved procuring pertinent medical service price reform documents from the Huanggang Medical Security Bureau.and the number of inpatients and average hospitalization expenses from 2018 to 2022 were obtained from the statistical statements of the public hospitals.The structural variation method and the new grey correlation method were used to analyze the composition of inpatient expenses and the changes of its influencing factors.Results:Over the period from 2018 to 2022,the growth rate of average hospitalization expenses per occurrence in tertiary public hospitals exhibited significant fluctuations.The degree of structural change in average hospitalization expenses was measured at 15.12%.Among them,the proportion of treatment expenses increased by 3.75%,the proportion of drug expenses and health materials decreased by 3.38%and 3.51%.Cumulatively,these three factors contributed substantially,accounting for 70.44%.The proportion of medical service income increased by 3.99 percentage points.The correlation between drug cost and average cost was 0.9092,which was still the most important factor affecting hospitalization expenses.Conclusion:After the implementation of the four medical service price reforms in Huanggang,the cost of drugs and sanitary materials has been well controlled,the proportion of medical service income has increased,and the structure of hospitalization expenses has been continuously optimized.However,there are still problems such as large changes in the average cost and low proportion of nursing fees.We should do a good job in the connection between price reform and supporting payment reform,continue to implement the policy of centralized procurement of pharmaceutical consumables,and increase the price of nursing service i

关 键 词：医疗服务价格改革 住院费用 三级公立医院 黄冈 

分 类 号：R-05[医药卫生] R197.3