浙江省县级公立医院改革政策实施效果评价

Outcomes evaluation of county-level public hospital reform in Zhejiang province

目的 了解浙江省县级公立医院综合改革政策实施效果,为改进改革措施、保证改革的有效性和可持续性提供参考依据.方法 选择2012年12月启动改革的38家综合型医院作为研究对象,收集其2012年1～6月和2013年1～6月的各项绩效指标,分析改革前、后的绩效变化情况.结果 浙江省县级公立医院实施综合改革政策后,医疗服务数量明显提高,门急诊总收入和住院总收入增加,药品收入比例下降（由54.41％下降至49.30％）;次均门急诊费用增加（年均增长0.75％）,次均住院费用减少（年均降低1.41％）;医务人员收入提高（增长6.04％）,医院收支结余增加.结论 通过改革减轻了患者的药品负担,但对医生处方行为及减轻患者看病总体负担的作用,值得进一步研究.

Objective To probe into reform outcomes of county-level public hospitals in the province,for the purpose of improving reform measures and ensuring validity and sustainability of the reform. Methods 38 general hospitals with ongoing reform since December 2012 were rounded up in the research. From these hospitals the performance indicators of January-June, 2012 and January-June, 2013 were collected and analyzed for comparison before and after the reform. Results The reform found a significant rise of medical services, an increase in the revenue of both outpatients and inpatients, and a proportional drop of drug sales（from 54.41~ to 49.30%）; an increase of outpatient costs per visit （0, 75%average annual increase）; a drop of hospitalization fees per person （1. 41% average annual decrease）; an increase of medical workers＇ income（6.04% increase）; and a budget surplus for the hospitals. Conclusion The comprehensive reform has reduced medicine cost burden for patients, yet its role in regulating physicians＇ prescription behavior and alleviating the general out-of-pocket burden of patients in general remains to be confirmed.