住院医疗费用控制的系统规制与微观治理分析

Analysis of System Regulation and Micro Management of Medical Costs Control in Hospital

对患者住院医疗费用构成及影响因素进行分析,探讨新医改后的医疗控费方向,以某县级市属人民医院的5205例住院病例为研究对象,通过研究发现:(1)人均住院费用构成中,药占比大幅度下降了,而检查治疗费与材料费占比很高;(2)病种、科室、医嘱变异率、临床路径完成情况、疾病转归对住院费用都有显著影响;(3)医疗控费,在宏观上需要系统规制,完善医保、规范医疗、改革医药等政策联动。在微观治理上应将一些有效的控费手段如临床路径进一步完善,提高完成率,减少变异率等。

This paper analyzes the composition and influencing factors of hospitalization medical expenses and discusses the direction of medical cost control after the new medical reform. Study of 5205 hospitalized cases in the People＇s Hospital of a county-level city generates the following results：（ 1） In the per capita hospitalization costs,the drug costs deline significantly,while the examination and treatment costs and material costs are on the rise;（ 2） The disease categories,the hospital department,doctors＇ advice,the completion status of the clinical pathway and the outcome of the diseases all have a significant impact on the costs of hospitalization;（ 3） The control of medical costs,on the macro level,needs to be linked with systematic regulation,perfection of health care,standardization of the medical service and medical care reform policy. On the micro level,we should further improve some effective control measures such as the clinical pathway,enhance the completion rate and reduce the rate of variation.