县级公立医院“取消以药补医”补偿机制的现状研究——以山西省第一批34个综合改革试点县为例

Research on compensation mechanism of canceling “medicine benefit supporting medical treatment” in counties hospital ——Take 34 comprehensive reform counties as the example

[目的]通过分析山西省第一批34个综合改革试点县中38所公立医院"取消以药补医"后财政补偿的基本情况,发现其中存在的主要问题,为建立更加科学合理的补偿机制提供依据。[方法]采用描述性统计分析方法对38个试点医院的财政补偿、医院收支等情况进行分析;采用Spearman相关分析法对试点公立医院的财政补偿与医院绩效之间的关系进行分析。[结果]山西省38所医院的财政补偿在逐年增加,2013年的平均补偿数额为1,666.39万元;38所医院在2011年国家开始加大财政补助的力度后,医院的收支结余也在增加;财政补偿与财政补助收入占药品加成和基本工资的比例呈显著正相关,与药占比成显著负相关。[结论]山西省对38所县级公立医院财政补偿制度的改革,在一定程度上取得了预期效果,但在改革的过程中也出现了一些问题。建议进一步明确政府责任,加强医院管理,改革支付方式。

Objective By analyzing the basic situation of finance compensation after canceling the policy of “medicine benefit supporting medical treatment” in 38 public hospitals of 34 counties, which are the first trials of the comprehensive reform in Shanxi province. We can find out major problem to provide the basis for building a more effective compensation mechanism. Methods Analyzed the financial compensation, hospitals income and expenses of 38 public hospitals by descriptive statistical analysis method, the relationship between finance compensation and performance by Spearman rank correlation method. Results The financial compensation was increasing year by year in 38 public hospitals, the average amount of financial compensation was 16.6639 million yuan in 2013. The balance of hospital payments was increasing alter improving the degree of financial compensation. It was a significant positive correlation in government financial compensation, the ratio of the financial subsidy income accounted for drug addition and the basic wage, but it was significant negative correlation in medicine proportion. Conclusions It obtained desired effect that financial compensation reform to 38 public hospitals. But there were some problems in this process. It suggests that to clear the government＇s responsibility, strengthen hospitals＇ management and reform the mode of payment.