县级公立医院综合改革对医院收支结构的影响研究

Research on the Impact of Comprehensive Reform of County Public Hospitals on the Structure of Hospital Revenue and Expenditure

目的评价S省县级公立医院综合改革,尤其是补偿机制改革对县级公立医院收支结构的影响。方法通过对88家县级综合公立医院2011—2015年收支数据进行统计处理,分析改革前后收支结构的变化。结果取消药品加成后,试点医院收入增长逐渐变缓,药占比下降明显,但是检查、检验和耗材收入出现替代性上升,医疗服务价格调整效果不明显。结论破除"以药补医"效果良好,但补偿机制改革未达预期,建议进一步理顺医疗服务价格,探索改革和建立政府财政投入长效机制。

Objective To evaluate the impact of comprehensive reform of county public hospitals in S Province,especially the reform of compensation mechanisms on the income and expenditure structure of county public hospitals.Methods Statistical analysis was conducted on the income and expenditure data of the 88 general hospitals from 2011 to 2015,and the changes of the income and expenditure structure before and after the reform were analyzed.Results After the elimination of drug addition,the income growth of the pilot hospitals gradually slowed down,and the proportion of the drug occupation ratio decreased obviously.However,the income of examination,inspection and consumables increased in a substitutable way,and the effect of medical service price adjustment was not obvious.Conclusion The effect of removing"supporting medicine with drugs"is good,but the reform of compensation mechanism is not expected.It is suggested to further rationalize the price of medical service,explore the reform,and establish the longterm mechanism of government financial input.