海口市公立医院补偿机制改革的经济效果评价

Evaluation on the Compensation of Public Hospitals in Medical Pricing Reform in Haikou

目的:评价不同类型的城市公立补偿机制改革的经济效果,为取消药品加成后财政差异化补偿方式提供依据。方法:选取海南省海口市24家城市公立医院作为样本,通过调取各医院的财务报表对改革前后的公立医院的运行效果进行评价,采用改革前后的公立医院收入、支出结构的财务分析方法。结果:(1)政府财政补偿投入不足,公立医院的业务收入仍是维持其运转的主要经费来源。(2)医疗服务项目价格调整并未起到优化医疗费用结构的杠杆作用,医生通过诱导需求等方式影响供给数量,弱化了价格的调整作用。(3)样本医院年收入增长速度放缓,虽然药占比降低,但药品收入仍是医院收入的主要来源;检查、化验费用比重呈现上升态势;挂号、诊察和护理等体现劳务和技术价值的比重偏低。结论:(1)进一步加大财政投入力度;提高补偿效率。(2)以支付方式改革为核心,全面提升医疗保险补偿绩效。(3)优化医疗服务价格体系,建立科学、合理的补偿机制,为劳务和技术服务提供补偿。

Objective: To evaluate the economic effects of medical pricing reform in different kinds of urban public hospitals, and thereby to provide an empirical basis for the financial differential compensation scheme after the abolishment of historically-allowed profit in drug sales. Methods: 24 urban public hospitals in Haikou, Hainan Province, were selected as samples and the financial statement were acquired. Through evaluating the operation effectiveness of public hospitals before and after the reform, the income and expenditure structure of financial analysis method were applied before and after the reform of public hospitals. Result:(1) The govemmenfs financial input was insufficient, and the business income of public hospital was still the main source of funds to maintain its operation.(2) The price adjustment of medical service project did not play an important role in optimizing the structure of medical expenses. Doctors influenced the quantity of supply by inducing demand, weakening the adjustment of price.(3) The growth rate of annual income of sample hospitals was slow, although the proportion of drug occupation was reduced, but drug income was still the main source of hospital income, and the proportion of inspection and laboratory cost was rising, and the proportion of registration, diagnosis and nursing were respectively low. Conclusion:(1) Further increasing financial input and improve the efficiency of compensation.(2) Taking the reform of payment method as the core to improve the performance of medical insurance compensation.(3) It should optimize the price system of medical services, establish a scientific and reasonable compensation mechanism, and provide compensation for labor and technical services.