补偿机制改革对县级公立医院业务收入及结构的影响

Impact of Compensation Mechanism Reform on Business Income and Composition of the County-level Public Hospital

目的分析补偿机制改革对县级公立医院业务收入及其结构的影响,为改革的进一步开展和调整提供依据。方法运用间断时间序列数据的分段回归模型,分析山东省某县级公立医院的业务收入以及其中各类目收入的金额和占比在改革后的即时变化和趋势变化。结果补偿机制改革后,样本县医院的总业务收入、门诊收入及住院收入的变化趋势均有明显的下降;在其构成方面,药品收入占比下降,而检查和治疗收入占比有所升高。结论补偿机制改革虽然减弱了药品对医院的经济激励,但服务价格的调整不足以补偿药品取消加成而损失的收入,医院的业务收入明显下降,并且具有变"以药补医"为"以检查补医"的趋势。

Objective To analyze the impact of compensation mechanism reform on the business income and com- position of the county-level public hospital, and offer evidence for further development and adjustment of the re- form. Method Using interrupted time series segmented regression model to analyze the instant change and trend change of business income, amount and percentage of each type of income, based on data collected from a coun- ty-level public hospital in Shandong Province. Result The trends of total business income, outpatient and inpatient in- come have declined after the reform, and the percentage of drug income has deceased while examination income and treatment income have elevated after the reform. Conclusion Although the economic incentive of drug to hospital has weakened after the compensation mechanism reform, the price adjustment of health service is far from enough to compensate the income decrease due to canceling drug additions, business income has declined significantly, and the problems of over relying on examination income have been emerging.