北京市某院两次医药分开改革对患者就诊行为的影响

Research of impacts on medical visit behaviors of patients due to the two reforms of the clinicpharmacy-separation at a hospital in Beijing

目的研究北京市医药分开试点和医药分开综合改革实施对门急诊患者就诊行为的影响及其差异。方法统计某院2012年12月医药分开试点改革、2017年4月医药分开综合改革前后门急诊患者收费发票信息，采用自身同期对照，分析患者费用类别信息，以探讨医药分开改革对患者就诊行为的影响。结果试点改革使医院门急诊人次下降5.29%，其中医保患者构成比上升6.86个百分点，单纯开药医保患者构成比上升4.30个百分点；综合改革后门急诊人次下降2.03%，其中医保患者构成比下降2.61个百分点，单纯开药医保患者构成比下降2.54个百分点。结论全市医药分开综合改革对患者的就诊行为产生了影响，医改效果正在显现。

Objective To study the impacts and the difference made by the pilot reform and comprehensive reform of clinic-pharmacy-separation on the medical visit behaviors of outpatients in Beijing.Methods Invoice information of outpatients′ fee payment during the December 2012 reform and April 2017 reform at the hospital was collected. Information of these patients at the same time as controls was collected to analyze patients′ fee categories, so as to study the effect on the behavior of these patients.Results The outpatient visits decreased by 5.29% as a result of the pilot reform. The ratio of medical insurance patients rose by 6.86%, and that of such patients seeking only prescriptions rose by 4.30%; number of outpatient visits decreased by 2.03% after the comprehensive reform, while the ratio of medical insurance outpatients dropped by 2.61%, and those seeking prescription only dropped by 2.54%.Conclusions The comprehensive reform of clinic-pharmacy-separation has influenced the outpatient′s medical visit behavior, evidencing a positive outcome of the healthcare reform.