基于系统动力学方法的公立医院补偿路径仿真分析

System dynamics simulation analysis of financial mechanism of public hospitals

文章运用系统动力学方法构建了公立医院补偿路径与补偿机制改革的流图模型,确定相关变量的函数关系,并利用该模型对取消药品统计加成和药品实际加成两种情况下公立医院的运行特征与产出变化情况进行了系统仿真。结果显示:从公立医院收支结余的稳定性和合理性来看,补偿机制转化应当取消药品的实际加成;取消药品实际加成后确定适度补偿的比例是关键,公立医院收支缺口不需要由财政路径和医疗服务路径完全补偿,医院自身有一个自我消化的空间;与取消药品统计加成相比,取消药品实际加成后公立医院不存在依靠药品收入的可能性,在适度补偿情况下医疗服务费用上涨也较为平缓,有利于控制公立医院医药费用的不合理增长;无论取消药品统计加成还是药品实际加成,公立医院补偿机制转化对门诊、住院量不会产生显著影响作用。

The flow chart model of financial mechanism reform on public hospitals was established by system dynamics meth- od,which had simulated the operation of public hospitals. The results showed that the financial mechanism reform on public hospi- tals should focus on cancelling actual drug mark up from the perspective of stability. Defining the appropriate reimbursement rate is the key point in financial mechanism reform after cancelling actual drug mark up. The public hospitals had self-assimilation space and do not need to be fully reimbursed by the fiscal path and medical services path. Compared with cancelling statistical drug mark up, it is not possible to obtain revenue from cancelling actual drug mark up,which is favorable to control the unreasonable increase of health expenditures. The financial mechanism reform will not have significant effect on outpatients and inpatients. Author＇s address Nanjing Medical University,Nanjing,P. R. China.