从医疗成本角度对医疗服务价格调整总量测算

Calculation and analysis of the total pricing adjustment of medical services based on medical costs

以上海市2013年经济运行数据为基础，将公立医院医疗成本分为人员支出、卫生材料费、药品费、其他支出四大类，分别对四类成本进行测算，并对其补偿渠道进行分析。通过测算认为，在当前财政补助模式下，取消药品加成后，为保持公立医院经济运行的可持续性，上海市医疗服务价格调整总量为75．0亿元～116．9亿元，门急诊次均费用要增加10．6～27．7元，每住院床日费用要增加76．7～151．4元；医保总支出要增加15．1亿元～33．3亿元，约占2013年上海市医保基金结余的7．3％～16．1％，占当年医保基金累计结余的2．2%-4．9％。因此，建议在综合考虑公立医院经济运行、医保基金承受能力、群众整体负担的前提下，结合降低药品耗材费用、规范医疗服务行为、开展医疗机构成本核算等措施，合理确定医疗服务价格调整总量。

The medical costs of public hospitals were divided into four categories of manpower cost, healthcare material cost, drug cost and other cost based on the business operating data of 2013 in Shanghai for calculation categories respectively, with analysis of their compensation channels as well. The calculation found that in the present financial subsidy pattern without drug price markup, the pricing adjustment of medical services in Shanghai was 7.50 billion to 11.69 billion yuan, which is necessary to maintain public hospitals as economically sustainable. Per-visit price of outpatient and emergency service should increase 10. 6 to 27. 7 yuan, average inpatient expense per bed day should increase 76. 7 to 151.4 yuan, and medical insurance expenditure should increase 1.51 billion to 3. 33 billion yuan, accounting for 7. 3% to 16.1M of the accumulated surplus of medical insurance fund of Shanghai in 2013. Based on the above, the paper recommended to set the total pricing adjustment of medical prices on a rational basis, in consideration of the business operation of public hospitals, affordability of medical insurance fund, and overall burden of the people, in line with such measures as lowering drug and consumable costs, regulating medical behavior, and encouraging medical institutions to engage in cost accounting.