取消药品加成医疗服务价格调整对住院费用影响分析——以四川省某省属三甲医院胆囊结石伴慢性胆囊炎为例

Analysis on Hospital Expenses after Calling off Drug-addition and Price Adjustment of Medical Service of a Provincial Third Class A Hospital in Sichuan Province——Gallbladder Stone with Chronic Cholecystitis As Example

目的:本研究通过分析四川省某省属三甲医院在2016年底四川省公立医院药品加成取消医疗服务价格调整政策实施前后,收治胆囊结石伴慢性胆囊炎行腹腔镜胆囊切除手术患者住院费用及其构成情况的变化,探讨变化的原因,对医院管理及医疗服务价格调整提出建议。方法:按照国际疾病分类标准(ICD-10)选取四川省某省属三甲医院2016~2017年的2341例胆囊结石伴慢性胆囊炎住院患者为研究对象。采用描述性分析,t检验、χ2分析对价格调整前后平均住院费用及其构成类别变化情况分析。结果价格调整后(1)药品费占住院费用构成比由28. 8%降低至22. 44%,材料费构成比由调整前第二位升至调整后第一位,其余类别费用构成比顺位不变;(2)平均住院日由5. 9天降至5. 21天(P <0. 05);(3)平均住院费用、材料费、检查费的变化无统计学意义,药品费、床位费降低,手术费、麻醉费、化验费、护理费、诊疗费上升,变化有统计学意义。结论药品加成取消及医疗服务价格调整对住院费用构成影响明显;进一步加强药品和耗材的管控,提高医护人员医疗服务价值。

Objective Through analyzing changes in hospital expenses and the composition of Gallbladder stone with chronic cholecystitis after calling off drug - addition and price adjustment of medical service of a provincial third class A hospital in Sichuan province, finding out the cause of the changes, to provide suggestions on hospital management and price adjustment of medical service. Methods According to the standard International Classification of Diseases （ICD - 10） and choose 2341 cases from 2016 to 2017 of hospitalized patients with gallbladder stones with chronic cholecyst＇itis as the research object in a provincial third class A hospital in Sichuan province. And using descriptive analysis, t -test and chi -square analysis method, to analysis changes in hospitalization costs and their constituent categories after ＇canceling the drug - addition and price adjustment of medical service. Results After canceling the drug - addition and adjustment of medical service price ： （1） the composition of drug charges decreased from 28.8% to 22.44% , material cost composition changed from the second before the adjustment to the first, the remai- ning category cost composition is unchanged; （2） the average hospital stay was reduced from 5.9 days to 5. 21 days; （3） the average hospitalization cost, material cost and examination fee between the two groups have no statistically significant difference. The medicine expenses, beds fee, operation expenses, anesthesia fee, inspection fee and nurse fee between the two groups has statisti- cally significant difference. Conclusion Canceling the drug - addition and price adjustment of medical service have a significant effect on the hospitalization expense composition, we should do our best to strengthen the control of medicine and material. Improve the doctors and nurses service value.