北京某医院实施医药分开综合改革试点效果分析

Analysis of the performance of the ＂Clinic-pharmacy separation＂ reform at a Beijing hospital

目的对北京市医药分开政策试点效果进行分析。方法采用纵向分析法，分析某试点医院2012年至2016年共60个月的运营数据，主要包括医疗统计报表、相关财务信息、HIS相关信息、上级部门信息以及现场患者就医感受信息等。结果试点医院医疗工作效率持续增长，2013年至2016年门诊量增长幅度为3．53％～15．20％，出院人数增长幅度为3．12％-8．48％；改革实施后的2012年9月至2013年8月，取消药品加成增收医事服务费的模拟转换收入为1221万元，实现了收入平移；医保基金负担未加重。医院药占比下降明显，5年来降幅高于15个百分点；患者门诊次均药费、出院例均药费逐年下降；患者认为与专家有足够的交流时间，对医生服务的总体满意度较高。结论北京市医药分开改革实现了试点医院收入不减少的目标；能够有效减轻患者负担；医保基金支付可控。建议进一步完善医师绩效激励与约束机制。

Objective To analyze the effects of the ＂ Clinic-pharmacy separation＂ reform in Beijing. Methods Following the chronological order, 60-month operational data of a pilot hospital from 2012 to 2016 were analyzed. These data included medical statistics reports, financial information, HIS information, authority information, and patients＇ satisfaction on site. Results Pilot hospital showed that its medical work efficiency continued to grow. During 2013 -2016, its outpatients volume growth rate ranged 3.53% - 15.20% , and its number of discharged patients growth rate ranged 3. 12% - 8.48%. The hospital harvested 12.21 million yuan of converted income from September 2012 （when the reform was in place to cancel the drug markup and collect medical service fees） to August 2013, scoring a smooth shift of revenue sources. Medical insurance fund expenditure did not increase as a result. The percentage of drug expense was significantly decreased, dropping over 15% in 5 years. Outpatient drug fees and inpatient drug fees continued to decline year by year. Patients expressed higher satisfaction over medical services due to longer time of consultation with physicians. Conclusions ＂ Clinic-pharmacy separation＂ reform has achieved the following objectives. The revenue is maintained stable; Patients flow is diverted under guidance, with less financial burden; and medical insurance expenditure is under control. We propose to improve the performance incentive and constraint mechanism for drug prescriptions by physicians.