北京市医改前后某院医疗服务质量与费用分析

Comparison of Medical Service Quality and Cost before and after the Medical Reform

目的分析医改对医院门诊量、住院医疗质量的影响,以及医改前后住院医疗费用与药费对比情况。方法筛选医改后2017年4月8日-2017年12月31日及医改前2016年4月9日-2017年1月1日的医疗服务质量与费用的部分指标,利用卡方检验和配对t检验方法,分析医改前后门诊量、医疗服务质量与费用的差异。结果医改后普通门诊量比例下降,专家门诊量比例上升了1.58%。医改后出院例数增长了7.32%,出院患者的平均住院日降低了0.47天,病床使用率提高了0.43%。住院患者总手术及介入治疗台次增长了7.64%。住院CT、MRI、PET-CT工作量增长了10.66%。医改前后各科室出院患者的例均费用统计学上无显著性差异,但是例均药费医改后比医改前显著降低,P<0.01,具有统计学意义。结论专家门诊量比例提高,普通门诊量比例降低。医改后住院医疗服务质量各项指标显著提高。费用方面体现医改费用的政策,总费用不变情况下,药费显著降低。

Objectives To study the effect of medical comprehensive reform on the number of hospital outpatient and the quality of medical service for inpatient, and compare the inpatients＇ total expenses and medicine expenses between before and after medical comprehensive reform. Methods This study screened some indexes of quality and cost of medical service, and analyzed the differences between the medical care quality and the cost of medical care before and after medical reform by using the chi-square test and the paired t-test method. Results After medical reform, the proportion of general out-patient visits decreased, and the proportion of expert outpatient visits increased by 1.58%.The number of discharged patients increased by 7.32%, and the average hospitalization day of discharged patients decreased by 0.47 days, and the hospital bed utilization rate increased by 0.43%.The number of total surgical and interventional treatment for hospitalized patients increased by 7.64%. The number of inpatients examined by CT, MRI and pet-ct was increased by 10.66%. There was no significant difference in the cost statistics of patients discharged from the hospital before and after the reform, but the cost reform was significantly lower than that before the reform. Conclusions The proportion of expert outpatient visits increased, and the proportion of common outpatients decreased. Medical reform plays an active role on the quality of hospitalization service. The cost could be reflected in the policy of medical reform, the total cost was unchanged, and the drug cost was significantly reduced.