取消以药补医对县级医院收入结构的影响

Impact of Abolishing Drug Make-up on Income Structure of County-level Hospitals

目的:评价我国县级公立医院实施取消以药补医政策后对医院收入结构和补偿渠道的影响。方法:在东、中、西部分别选取具有典型代表性且改革时间接近的三个地区共22所县级公立医院,分析这22所公立医院在改革前后收入结构的变化,并与全国同期水平相对比。结果:改革后,样本地区的财政支持力度高于全国平均水平。样本医院的门急诊和住院收入药占比持续下降,下降幅度大于全国水平。门急诊收入检查占比由上升转为下降,同期全国公立医院门急诊收入检查占比持续上升;住院收入检查占比由下降转为上升,同期全国则减速上升。结论与建议:取消以药补医改革对县级公立医院的收入结构,尤其是门急诊收入的结构产生了正向的影响,但住院检查占比在改革后反而由改革前的下降转为上升。

Objective:To assess the effects on income structure of conducting abolishing drug make-up policy in county-levelpublic hospitals of China.Methods:Through analyzing 22 county-level public hospitals abolishing drug make-up policy in 3 typicalrepresentative regions with closer reforming time chosen from eastern, central and western regions, the data from 2010 to 2012 wereanalyzed; the changing trends and changing degrees of different indicators before and after the reform were compared with the nation-al level at the same period.Results:The fiscal supporting level of sample region was higher than national average level after reform.The proportion of drug income in outpatient and outpatient of sample hospitals kept decreasing, the drop was greater than the nationalaverage level. The percentage of outpatient emergency examine in hospital income changed from decreasing to increasing, meanwhile,the proportion of emergency examine income of national public hospitals kept increasing; the proportion of inpatient income changedfrom decreasing to increasing, meanwhile, the national level slowed the increasing speed.Conclusion and Suggestion:The effect ofabolishing drug make-up on income structure of county-level hospitals was positive, especially on outpatient service income, but thepercentage of examination income in inpatient service income degenerated from decreasing to increasing after the reform.