基于河南省某试点县级公立医院“取消药品加成”政策实施效果研究

Investigation of Drug Zero Bonus Present Situation in a County-level Public Hospital in Henan Province

目的研究县级公立医院"取消药品加成"政策实施效果,为进一步完善相关政策提供参考。方法对某县级公立医院"取消药品加成"政策实施前后医药费用控制、医院收支、补偿情况等数据进行对比分析,以研究政策实施的实际效果。结果政策实施后药占比下降,由政策实施前的43.6%降至政策预期目标(30%);药品总费用增长率低于政策实施前,增速放缓;门诊病人次均药费、住院病人人均药费减少,差异具有统计学意义。门诊病人次均医药费用下降;住院病人人均医药费用并无明显下降;医疗总费用呈增长趋势,增长率先降后升,接近政策实施前的水平。同时县级医院收入结构趋于合理,但收支结余大幅下降。由政府增加投入及调整医疗服务价格而增加的医院收入不足以弥补"取消药品加成"所带来的损失。结论 "取消药品加成"政策在该县级公立医院实施以来,对控制医疗费用增长有一定作用,控制药品费用增长效果明显。患者医药费用下降。为巩固成效,还应建立多方共担长效补偿机制,同时重视医务人员收入的提高。

OBJECTIVE To study the effect of ＂cancel drug addition＂ policy in county public hospitals, and to provide reference for further improvement of relevant policies. METHODS This paper copapares the data of medical expenses control, hospital income and expenditure, compensation and so on before and after the policy of ＂ canceling the drug addition＂ of a county public hospital to study the actual effect of policy implementation. RESULTS The proportion of drugs after the implementation of the decline, from the policy before the implementation of 43.6% to the policy objectives （ 30% ）. The total cost of drug growth rate is lower than before the implementation of the policy, the slowdown in growth; outpatient average medical expenses, inpatient per capita reduction in drug costs, the difference was statistically significant. The average cost of medical care was increasing, and the growth rate dropped first and then rose, which was close to the level before the implementation of the policy. At the same time, the income structure of the county- level hospitals tends to be reasonable, but the balance of payments has dropped significantly. The increase in hospital investment and adjust the price of medical services increased hospital income is not enough to make up for the ＂cancellation of drug additions＂ brought about by the loss. CONCLUSION ＂Cancellation of drug addition＂ policy in the county-level public hospitals since the implementa- tion of the control of medical expenses have a certain role in the control of drug costs growth effect is obvious. Patient medical expenses are falling. In order to consolidate the effectiveness, but also the establishment of multi-share long-term compensation mechanism, while paying attention to the increase in medical staff income.