公立医院胃癌根治术直接成本与政府定价关系研究

Research on relationship between direct cost and government mandated price in radical operation for gastric cancer in public hospitals

目的比较公立医院胃癌根治术的直接成本与定价的差距,分析定价的合理性。方法采用典型抽样方法,分别选取上海市、浙江省、湖北省和陕西省各一家三级医院作为样本医院,根据计算的胃癌根治术项目直接成本和手术收费标准,测算每例胃癌根治术的收费价格水平(收费标准/直接成本),并加以分析。结果在上海市、浙江省、湖北省和陕西省的样本医院中,平均每例手术的直接成本分别为2 628.96、3 078.79、3 634.17和1 839.49元;手术收费标准分别为1 860、1 860、2 000和1 880元。上海市、浙江省和湖北省样本医院的收费价格水平均<1(0.71、0.60和0.55),陕西省为1.02。结论各地区公立医院胃癌根治术的直接成本有较大差异,政府定价基本上均低于直接成本。适度调整医疗服务价格是扭转当前不合理的医疗成本补偿机制的有效途径。

Objective To explore the differences between direct cost and government mandated price in radical operation for gastric cancer in public hospitals, and analyse the rationality of pricing mechanism. Methods Four hospitals were selected by representative sampling from Shanghai, Zhejiang Province, Hnbei Province and Shaanxi Province. Based on the calculated direct cost and collected charge standard of radical operation for gastric cancer, the price level （ charge standard/ direct cost） for each radical operation for gastric cancer was measured and analysed. Results The mean direct cost of each radical operation for gastric cancer was 2 628.96 yuan, 3 078.79 yuan, 3 634.17 yuan and 1 839.49 yuan in Shanghai, Zhejiang Province, Hubei Province and Shaanxi Province, respectively, while the charge price was 1 860 yuan, 1 860 yuan, 2 000 yuan and 1 880 yuan, respectively. The price level of sample hospitals in Shanghai, Zhejiang Province and Hubei Province was less than 1 （0.71,0. 60 and 0. 55, respectively）, while that in Shaanxi Province was 1.02. Conclusion There are definite differences in direct cost of radical operation for gastric cancer among public hospitals in various regions, and the government mandated price is lower than the direct price on the whole. A proper adjustment of charge price for medical service may be an effective approach to reverse the current irrational compensation mechanism for medical cost.