“十二五”期间北京市医疗机构费用变动情况分析

Analysis on the Cost Changes of Total Health Expenditure of Medical Institutions in Beijing During the 12^(th) 5-year Plan Period

目的分析"十二五"期间北京市医院和社区卫生服务机构费用变动的情况,为推进医疗卫生服务体系建设提供建议。方法利用个案库进行汇总的方法核算北京市医疗机构费用,对构成比和增长速度进行统计分析。结果 2011—2015年期间,北京市医疗机构费用总计环比由2012年的20.97%下降至2015年的10.05%,社区卫生服务机构总费用年均增长速度(15.54%)快于城市医院(13.78%)。药品费在门诊和住院各费用中占比分别从64.04%、33.71%下降至62.51%和31.60%,检查费在门诊费用中的占比从8.51%上升至8.75%,化验费在住院费用中的占比从8.66%上升至9.26%。结论北京市卫生总费用在一定程度上得到了控制,并逐年向社区卫生服务机构倾斜;药品费占比呈逐年下降趋势,而其他收费占比则逐年上升。应进一步加强社区卫生服务体系内涵建设,推进分级诊疗制度,同时需注重破除"以药养医"体制,控制其他费用的增长。

Objective To analyze the factors influencing the change of hospitals and community health service institutions＇ expense in Beijing from 2011 to 2015 based on the total health expenditure accounting results and provide suggestions for promoting the construction of medical and health service system.Methods The method of case library was used to calculate total expenses of medical institutions and statistical analysis was carried out by using composition ratio and growth rate.Results During the＂12-（th） Five-Year Plan＂period,the growth rate of hospital and community health service institutions＇ total expenditure in Beijing decreased from 20.97% in 2012 to 10.05% in2015.The total annual growth rate of community health service institutions was 15.54%,which was 1.76% higher than that of urban hospitals.The drug＇s proportion of medical expenses and hospitalization expenses decreased from 64.04% and 33.71% to 62.51% and 31.60% respectively.The check fee＇s proportion of the cost of outpatient service increased from 8.51% to 8.75%,and the treating fee＇s proportion of the cost of hospitalization expenses increased from 8.66% to 9.26%.Conclusion The total health expenditure of Beijing has been controlled to a certain extent and it has been tilted to the community health service institutions year by year.At the same time,the drug＇s proportion of medical expense was showing a downward trend year by year,while the other charges＇ proportion of medical expense was increasing year by year.The construction of the community health service system should be strengthened and the construction of hierarchical diagnosis and treatment system should be promoted.We must pay attention to get rid of ＂ medicine to support the medical＂ while controlling other fees＇ growth appropriately.