江苏省医药价格改革对医保费用变化的影响

Medical insurance cost changes before and after medical price reform in Jiangsu

2015年底,江苏省公立医院医药价格改革全面实施,文章通过收集某大型公立医院两个代表性临床科室(肿瘤科、泌尿外科)改革前后一年医保相关数据,发现此次医药价格改革在优化科室医疗费用结构,提升医务工作者劳动价值,控制医保费用增长过快等方面取得了一定的成效。但是,在建立科学合理的医疗服务成本测算方法、调整机制和监管机制等方面的举措还有进一步改善的空间。

At the end of 2015,the medical price reform in public hospitals in Jiangsu was implemented in an all-round way.In this paper,we collected the medical insurance related data of two major representative clinical departments（oncology and urology） from a large public hospital a year before and after the reform.Then,we found that the medical price reform had achieved some success in the optimization of medical expenses structure,improving the labor value of medical workers,and controlling health insurance costs grow too fast.However,there is still room for further improvement in the establishment of scientific and rational measures such as cost measurement methods,adjustment mechanisms and regulatory mechanisms.