北京市基层医疗卫生机构药品零差价政策实施现状及问题研究

Problems in the Implementation of Zero-profit Drug Policy in Primary Healthcare Institutions in Beijing

背景“看病难、看病贵”是医药卫生体制改革的根本问题,而控制医疗费用、提高医疗质量是医药卫生体制改革的关键环节。2010—2015年北京市卫生支出逐年增长,2013—2016年北京市一级医院门诊人次增长率高于三级医院门诊增长率,通过对北京市一级医院医药费用进行分析,理清医药卫生体制改革的关键问题,可达到控制医疗费用的目的。目的以北京市海淀区田村路社区卫生服务中心为例,分析北京市基层医疗卫生机构实施药品零差价政策的现状及存在的问题,为基层医疗卫生机构改革提出建议。方法北京市海淀区田村路社区卫生服务中心2013—2017年相关统计数据来源于北京市海淀区田村路社区卫生服务中心医院信息系统(HIS)。2018年7月,选取2013—2017年门诊人次、门诊药占比、门诊次均费用、医药收入(医疗收入、挂号/诊疗/医事服务费收入、检查/化验收入、卫生材料/其他收入、药品收入)及门诊检查化验(普通放射检查、B超检查、全血细胞分析)例次和收入,分析2014—2017年各指标较2013年的变化情况(变化量及变化率)。结果2013—2017年门诊人次逐年增加;2017年门诊人次较2013年增加105.90%。2013—2017年门诊药占比处于波动状态;2017年门诊药占比较2013年增加0.40%。2013—2016年门诊次均费用逐年增加,之后有所降低;2017年门诊次均费用较2013年增加29.89%。2013—2017年医疗收入呈波动状态;2017年医疗收入较2013年增加149.06%。2013—2017年挂号/诊疗/医事服务费收入、检查/化验收入、卫生材料/其他收入、药品收入逐年增加;2017年挂号/诊疗/医事服务费收入、检查/化验收入、卫生材料/其他收入、药品收入较2013年分别增加1695.32%、75.32%、957.88%、167.45%。2013—2015年普通放射检查例次、收入逐年增加,之后逐年减少;2017年普通放射检查例次、收入较2013年分别增加206.45%、10.24%。2013—2016年B超检查例次逐年增加,之后有所降低;2017年B超检查例次较2013年增加74.47%。2013—2017年全血细胞分析例次、B超检查收入逐年增加;2017年全血细胞分析例次、B超检查收入较2013年分别增加87.67%、208.50%。2013—2017年全血细胞分析收入呈波动状态;2017年全血细胞分析收入较2013年增加237.69%。结论2013—2017年北京市药品费用增长渐趋平稳,医疗收入、检查/化验等费用明显增加,尤以挂号/诊疗/医事服务费收入增长为著,其次为卫生材料/其他收入,说明北京市基层医疗卫生机构实施的药品零差价政策取得了较为明显的成效。在药品费用渐趋平稳的同时,卫生耗材增长较快,下一步应建立卫生耗材监督管理机制。

Background To China's healthcare system reform,the essential problem needs to be solved is"difficult and expensive to access healthcare services",and the key link is healthcare costs control and medical quality improvement.Beijing had a gradual yearly increase in healthcare expenditure from 2010 to 2015,and a higher annual growth rate of outpatient visits in primary hospitals rather than tertiary hospitals during 2013—2016.By analyzing the healthcare costs in primary hospitals in Beijing,the essential problems during the healthcare system reform may be identified,which may help to control healthcare costs.Objective To identify the problems during the implementation of zero-profit drug policy in Tiancun Community Health Center,Beijing,putting forward suggestions for the reform in primary hospitals.Methods The statistical data between 2013 and 2017 of Tiancun Community Health Center,Haidian District,Beijing were obtained from HIS of the center during July,2018,including the number of outpatient visits,percentage of reimbursed outpatient drugs,average outpatient visit cost,earnings from medical and pharmaceutical services(earnings from delivering medical services,registration/diagnosis/treatment/management of medical matters,examinations/tests,health materials/others,and pharmaceutical services),number of outpatient examinations/tests(general radiological examinations,B-mode ultrasound examinations,whole blood cell tests),and corresponding earnings.The aforementioned parameters in 2013 were compared with those in 2014—2017 to find out the amount and rate of changes.Results From 2013 to 2017,the number of outpatient visits increased year by year,which increased by 105.90%in 2017 compared with 2013.The percentage of reimbursed outpatient drugs showed a trend of fluctuation,and increased by 0.40%in 2017 compared with 2013.With regard to average outpatient visit cost,a gradual yearly increase was seen between 2013 and 2016 but then a slightly decrease was seen,and it in 2017 increased by 29.89%compared with 2013.The earnings from medical services showed a trend of fluctuation during the period,and it had an increase of 149.06%in 2017 compared with 2013.The earnings from delivering registration/diagnosis/treatment/management of medical matters,examinations/tests,health materials/others,and pharmaceutical services showed an increase trend,and obtained growth rates of 1695.32%,75.32%,957.88%,and 167.45%,respectively,in 2017 compared with 2013.The number of general radiological examinations showed a gradual yearly increase between 2013 and 2015 and then a gradual yearly decrease,so did the earnings from delivering such services.And compared with 2013,they showed an increase of 206.45%,and 10.24%,respectively,in 2017.The number of B-mode ultrasound examinations showed a gradual yearly increase between 2013 and 2016 and then a slightly decrease,and the earnings from delivering such services showed a gradual yearly increase between 2013 and 2017.Compared with 2013,they showed an increase of 74.47%,and 208.50%respectively,in 2017.The number of whole blood cell tests showed a gradual yearly increase,and the earnings from delivering such services showed a trend of fluctuation between 2013 and 2017.Compared with 2013,they showed an increase of 87.67%,and 237.69%,respectively,in 2017.Conclusion During 2013 to 2017 in Beijing,the earnings from medical services and costs of examinations/tests and others had a significant increase,among which earnings from registration/diagnosis/treatment/management of medical matters had the largest increase,followed by earnings from health materials/others,but pharmaceutical costs had a stable increase,indicating that the effectiveness of implementing zero-profit drug policy is remarkable.In view of the rapid increase in the amount of consumed health materials,a supervision and management system for health materials consuming is suggested to be established.