“取消药品加成增设医事服务费”后次均费用模拟测算

Simulation Research on Mean Medical Expenses of“Abolishing Drug Addition and Setting Medical Service Cost”:Based on the Empirical Analysis of a Tertiary Hospital

目的:针对国家全面推开的"取消药品加成,增设医事服务费"政策进行门诊、住院医疗费用实际模拟测算。方法:利用江苏省扬州市某三级医院2005-2015年门诊及住院医疗消费数据,结合北京市当前试点标准和陕西省宝鸡市测算方法,分别设定为方案1和方案2,将药占比、门诊患者流向、次均补偿等作为研究指标,利用SAS 9.3统计软件对数据进行整理与分析。结果:(1)政策调整后方案2测算的结果低于实际值,表明减少的部分为政策性亏损,需当地政府提供相应的政策补助,方案1测算结果略高于实际值,需结合当地情况适当下调医事服务费标准;(2)以门诊及住院实际次均费用为标准,针对门诊及住院分别制定方案3和方案4,平均相对误差分别为7.99%和2.47%接近实际值;(3)模拟该医院政策调整后门诊减少14.05%,其中专家门诊减少14.61%,普通门诊减少3.96%;(4)门诊及住院调整后方案1和方案2医保基金补偿百分比均高于调整前。结论:新医改方案的制定与实施,不但有效的缓解了"看专家难"的现状,而且也使得药占比得到了有效的控制。但政府部门也应注意到新政策实施所带来的医院政策性亏损,结合当地实情制定相应的补偿方案。

ObjectiveSimulating the mean medical expenses of outpatient and inpatient according to abolish Drug Mark-up and add medical service fee which will be promoted to the whole country. Method： The data came from a tertiary hospital in Yangzhou City, Jiangsu Province which included outpatient and inpatient medical expenses during 2005 to 2015. Using the standards in Beijing City and the method in Baoji City, Shaanxi Province, we set Plan 1 and Plan 2 respectively. The indexes included mean medical expenses, drug proportion, patient flow and compensation. The SAS 9.3 Statistical software also used to collect and analyze the data. Results： ①The mean medical expenses of outpatient and inpatient showed a slow growth trend after inflation-adjusted. Annual average increase rate were 9.75% and 7.68% respectively; ②The results from Plan 2 were lower than the actual expenses. It shows that the lost was caused by policy related losses, which should be provide subsidies by the local government. But the results from Plan 1 were higher than the actual expenses. It means that the standard of medical service fee should be cut.③Taking the actual expenses of outpatient and inpatient as standard, we formulated Plan 3 and Plan4. The relative average error were 7.99% and 2.47%, closed to the actual expenses.④After adjustment of the hospital policy, the outpatient service was reduced by 14.05%, among which the specialist clinics was reduced by 14.61%, the general service was reduced by 3.96%.⑤Both of the Plan 1 and Plan2 medical insurance fund compensation percentage were higher than before. Conclusion： The formulation and implementation of the new medical program is not only effectively alleviated the situation of difficulty of getting specialist, but also made drug proportion reduce. However, the government should also pay attention to the policy related losses caused by the implementation of the new policy. It is necessary to formulate compensation schemes according to the local conditions