不同类型公立医院医药价格综合改革的补偿效果评价

Evaluation of Compensation of Different Kinds of Public Hospitals in Pharmaceutical Pricing Reform

目的评价城市公立医院医药价格改革在不同类型医院的实施效果,为取消药品加成后的财政差异化补偿方案提供实证依据。方法选取相关指标,应用间断时间序列模型对南京市3家代表不同类型城市公立医院改革前后的收支及补偿情况进行分析。结果 (1)综合和药品依赖型医院改革后门诊药占比分别为48.20%和57.23%,综合药占比仍较高;(2)住院患者次均药费下降明显,约为9%～21%;(3)医疗服务收入增长显著;(4)服务补偿率和综合补偿率在不同类型医院之间存在差异。结论针对服务补偿率提供差异化财政方案,同时进一步上调医疗技术服务价格,建立科学、合理的动态补偿机制,进一步补偿技术服务提供。

Objective To evaluate the effect of pharmaceutical pricing reform in different kinds of urban public hospitals,and thereby to provide an empirical basis for the financial differential compensation scheme after the abolishment of historically-allowed profit in drugs sales. Methods Selecting relevant indicators,and applying discontinuous time series model to analyze the change of expenditure and compensation in 3 representative public hospitals in Nanjing City before and after the reform. Results（1） The outpatient drug proportion of comprehensive hospital and drug dependent hospital after the reform accounted for 48.20% and 57.23% respectively,and the comprehensive drug proportion is still high.（2） The inpatient average drug cost all declined significantly by about 9%-21%.（3） There was a significant increase in medical service income.（4） There were differences between service compensation rate and comprehensive compensation rate in different kinds of hospitals. Conclusion Differentiated financial scheme should be provided according to the service compensation rate, and the price of medical technology services should be further arosed. While a scientific and reasonable dynamic compensation mechanism shoulde be established,and further compensate for technical service be provided.