乌鲁木齐市某三甲医院综合改革前后医疗收入结构分析

Analysis of Income Structure Before and After Comprehensive Reform of a Third-Class Public Hospital in Urumqi

目的探讨药品加成取消和医疗服务价格调整的综合医疗改革对新疆乌鲁木齐市某三级甲等医院门诊与住院收入结构的变化。方法采用经济学中的结构改变度方法分析2016年-2018年医院门诊与住院收入构成在改革前后的改变。结果 2016年-2018年门诊收入结构改变度最明显,达到了15.71%,平均变动幅度为5.24%,药品在三个区间内均为负向变动,诊查、治疗、手术项目的收入均呈正向变动,在门诊收入的占比有上升趋势。2016年-2018年药品、诊查、治疗项目是影响门诊收入结构的关键因素,其累积变动率达77.66%。2016年-2018年住院收入构成改变最明显,结构改变度为30.98%,平均变动振幅为10.33%,药品项目在三个时间段均呈反向变动,改革重点要提高的费用项目如床位、治疗、护理、手术项目的收入均是正向变动,在住院收入中的构成比都有所提升。2016年-2018年药品项目、治疗及护理项目对住院收入构成改变贡献较大,其累积改变率达84.07%。结论医改后医院的医疗收入结构大致优化,体现医务人员劳动价值的收费项目有所提升,药占比呈现下降趋势,检查与化验项目结构变动不合理,医院费用结构需进一步优化。

Objective To explore the effect of the comprehensive reform of cancellation of drug additive income and the adjustment of medical service price on the income structure of outpatient and inpatient services of a third-class hospital in Urumqi, Xinjiang. Methods The degree of structural change in economics was used to analyze the changes of outpatient and inpatient income composition before and after the reform in the three years from 2016 to 2018. Results From 2016 to 2018, the degree of structural change of outpatient income structure changed obviously, reaching 15.71%, with an average annual change of 5.24%. Drug changed negatively in the three periods.The income of diagnosis, treatment and surgery items all changed positively, and their proportion of outpatient income increased. Drug,diagnosis and treatment items are the key factors affecting the outpatient income structure from 2016 to 2018. Their cumulative change rate is 77.66%. From 2016 to 2018, the structure of inpatient income changed the most obviously, with the degree of structural change being 30.98%, and the average annual change being 10.33%. Drug changed reversely in three periods. The key items of reform, such as bed, treatment, nursing and operation income, all changed positively, which indicated that their proportion of inpatient income has increased.From 2016 to 2018, drug items, treatment and nursing items contributed greatly to the change of the inpatient income structure, with the cumulative contribution rate reaching 84.07%. Conclusions The initial results of the reform are as follows,the hospital medical income structure is roughly optimized, and the fee items reflecting the labor achievements of medical staff have been improved after the reform. The proportion of drugs has shown a downward trend. The change of the income structure inspection and chemical items is unreasonable, and the structure of hospital expenses needs to be further improved.