南京市取消药品加成改革患者评价及影响因素研究

Patients Perception and its Influence Factors of Drug Markups Removal Reform of Urban Public Hospitals in Nanjing City

目的了解取消药品加成改革后患者实际费用支出及对价格变化的评价与诉求,分析患者评价影响因素,并提出针对性建议。方法采用随机抽样的方式对南京市16家城市公立医院640名患者进行满意度的调查,采用多水平模型对个体和医院水平的影响因素进行分析。结果患者负担方面,改革后城职保、城居保患者自付比分别上升0.14和0.56个百分点,患者负担有所升高。74.4%的患者赞成下降药价,69.8%的患者赞成上调服务项目价格。分别有66.3%和83.1%的患者希望扩大医保报销范围和比例。就诊类型和患者经济状况影响其对改革的评价,继而影响患者对服务费上升的态度。不同医院患者对服务价格上调的态度有显著性差异,但差异方向不一定。结论加强改革宣传,提高患者对改革的认知程度,增进患者对改革的理解,从而提高患者满意度。

Objective To learn the out-of-pocket money and patients’ perception about the drug markup removal reform in urban public hospitals with potential influencing factors,with the propose to improve the patient satisfactory degree. Methods A total of 640 patients were randomly sampled from 16 hospitals in Nanjing City,and hierarchical model was used to explore the influential factors from both individual level and hospital level. Results After the reform,the out-of-pocket money increased by 0.14% and 0.56% from urban employee scheme and urban resident scheme,respectively. 74.4% and 69.8% of the respondents were positive of removing the drug markups and increasing the prices of medical service,respectively. 66.3% and 83.1% of the respondents were in favor of expanding the reimbursement category and level,respectively. The influential factors were visit type,income level,perception of the reform and hospital,but there was temporarily no influential factors on the hospital level. Conclusion Measures should be proposed to improve the understanding towards reform in order to improve patients’ satisfaction.