某公立医院2010年-2015年住院医疗费用结构变动情况分析

Analysis on the Medical Expenses Structure Variation Situation in a Public Hospital from 2010 to 2015

目的分析新医改后医院住院医疗费用的结构变动情况,并探讨原因、为优化医疗收入结构,合理控制住院医疗费用提供参考依据。方法利用结构变动值、结构变动度和结构变动贡献率等评价指标,分析医院2010年-2015年住院医疗费用结构变动情况。结果新医改后人均住院费用增速放缓;药品费结构变动贡献率35.57%在各项目中居第一位,药品费的变动是导致住院医疗费用结构变动的主要因素;项目之间存在费用转移现象;住院医疗费用上涨主要是由化验费、治疗费、手术费、检查费引起,四项累计贡献率为48.66%,其中化验费是造成住院医疗费用不合理增长的主要因素;部分体现医务人员技术价值的项目收入在住院医疗费用中占比过低,有的仍呈负向变动趋势。结论医院应继续加强对住院医疗费用的管控,将住院医疗费用增长控制在合理范围。费用结构不合理,体现医护人员技术价值的项目收入在住院医疗费用中的比重过低。医疗机构应该优化医疗服务项目收入结构,提高医务人员的劳务技术价值。

Objectives ＂To analyze the structural changes of hospital medical-expenses and to explore the causes after the new medical reform, then to provide reference for optimizing the medical income structure and reasonable control of hospital medical expenses. Methods The structural changes of hospital medical expenses from 2010 to 2015 were analyzed by the indicators of structural change value, structural change degree and structural change contribution rate. Results After the new medical reform, per capita hospitalization expenses were slowdown. The structural change contribution rate of drug costs was 35.57%, ranking first in all projects. Expended changes was the main factor causing hospitalization medical expenses structure changes, transfer among projects cost of hospitalization. The rose of inpatient medical expenses mainly caused by the laboratory fees, treatment fees, operation fees, and inspection fees, and the cumulative contribution rate of the four items was 48.66%. The laboratory fees were the main factors leading to unreasonable growth of inpatient medical expenses. Part projects income that reflects the technical value of medical personnel in the proportion of inpatient medical expenses was low, some of which still showed a negative trend. Conclusions Hospitals should continue to strengthen the control of hospital medical expenses, and the hospital medical expenses growth should be controlled in a reasonable range. The structure of medical expenses was unreasonable. The proportion of project income that reflected the technical value of medical personnel in the inpatient medical expenses was too low. Medical institutions should optimize the income structure of medical services and improve the medical staff services technology value.