北京市外来就医与购药对卫生总费用核算平衡的影响

Impact of non-residents' health spending on the regional health expenditure of Beijing

目的:揭示外来就医与外来购药费用对北京市卫生总费用核算平衡的影响程度。方法:外来就医数据以北京市卫生局公共卫生信息中心年报和部分医院内部信息化统计结果为主,外来购药费用的收集采用抽样调查的方法。结果:2011年,北京市外来就医、购药费用313.60亿元,占卫生总费用来源法与机构法核算结果总差异的77.23%。来源法大于机构法核算结果且差异较大的黑龙江和吉林两省居民均在北京有较大比例的就医或购药行为。结论:北京市医疗系统承担了大量外地来京患者的医疗服务;药品零售机构药品销售费用中包含较高比例的外来消费,名优企业贡献突出;外来就医与外来购药是影响卫生总费用核算平衡的主要原因。建议:北京市卫生资源配置要充分考虑外来就医和购药因素;增加中央转移支付,缩小地区医疗资源差距;对外来就医、购药的研究应充分利用现有数据,并适当结合现场调查。

Objective： To analyse the impact of non-residents＇ health spending on the regional health expenditure of Beijing. Method： Statistical data from Beijing Municipal Health Bureau and sample hospitals was used to calculate the health spending of non-residents in Beijing. A sample survey in retail pharmacies provided the data which could be used to measure medicines spending of non-residents. Result： The health spending of non-residents in Bei- jing is RMB 31.36 billion per year, which accounts for 77.23% of the difference between the regional health expend- iture by the source and by the provider in Beijing. For example, health spending in Beijing of residents coming from Heilongjiang and Jilin provinces was considerable. Conclusion： The health system of Beijing has provided a large a- mount of health services to non-residents from other provinces. Sales in retail pharmacies also includes considerable medicines spending of non-residents. Non-resident health spending is the main reason for the difference between health expenditure by the source and by the provider in Beijing. Suggestion ： Health spending of non-residents should be considered as an important composition of the regional health expenditure when making policy of health resource allocation in Beijing. The central government ought to increase finance transfer payments to reduce disparities between the rich and poor areas. Existing data, as well as doing the necessary survey, is preferred to the research of non-resident health seeking behavior.