广东省县级公立医院取消药品加成政策后的影响及对策研究

Study on impact and strategies of county-level public hospital in Guangdong Province after drug price addition cancelled

目的分析广东省县级公立医院取消药品加成政策后对患者负担、医院收入以及医院经济补偿的影响,为推进县级公立医院改革提出针对性的建议。方法在全省60个县(市)125家试点公立医院中随机抽取5家医院进行现场调研,调查内容主要包括取消药品加成前后(2011~2014年)患者门急诊费用、住院费用、医院各项收入指标、药占比以及经济补偿情况。结果取消药品加成政策后,患者负担以及医院收入变化并不明显(P>0.05);医院药占比平均下降了2.12%(P<0.05);通过调整医疗服务价格只能补偿由于取消药品加成而减少的收入的40%~60%(P<0.05)。结论取消药品加成政策,取得了一定成效,但是没有完全达到改革的预期效果。药品加成只是医疗费用高昂的原因之一,必须采取综合措施去降低医疗费用。

Objective To study the impact on the patient burden, business income, and compensation mechanism of county-level public hospital in Guangdong Province after the drug price addition is cancelled, provide some pertinent strategies in order to promote the reform of county-level public hospital. Methods Field survey was conducted in 5 county-level public hospitals in 60 counties in Guangdong Province which was selected randomly form 125 reform hos- pitals. The survey mainly included the outpatient and the hospitalization expenses of patients, income indicators, drug proportion and compensation mechanism of hospitals from 2011 to 2014. Results After cancelling the drug price addi- tion, the change of the patient burden and the business income was not obvious （P 〉 0.05）. The drug proportion de- clined 2.12% （P 〈 0.05）. The increasing income by adjusting the medical price just compensated 40% to 60% of the decreasing income for cancelling the drug price addition （P 〈 0.05）. Conclusion The policy to cancel the drug price addition obtains the certain result, but does not achieve the desired effect of reform. And drug price addition is just one of the reasons for high health care costs, so the comorehensive measures must be taken to reduce the health care costs.