医药分开综合改革对北京某三甲医院的影响分析与评价

Analysis and Evaluation on the Effect of the Medical Separation Reform on a Three A and Tertiary Hospital in Beijing

目的分析北京某三甲医院实行医药分开综合改革2年来的运行情况及改革效果。方法采用自身同期对照法,对比改革前2年(2015年4月8日-2016年4月7日)、改革前1年(2016年4月8日-2017年4月7日)、改革后1年(2017年4月8日-2018年4月7日)与改革后2年(2018年4月8日-2019年4月7日)4个时间段的医疗数据,并对跨期变化情况进行配对t检验,从医疗服务、药费情况、收入结构等方面分析医院运行情况及改革效果。结果改革后较改革前相比,门(急)诊量下降12.57%,出院人数上升17.34%;医疗收入稳定增长,药占比下降35.84%,门诊次均药品费及出院患者次均药品费分别下降32.10%和25.61%,差异均具有统计学意义。大型设备检查收入占比下降5.89个百分点,技术劳务收入占比上升28.76个百分点。结论医药分开综合改革实现医疗机构的分级诊疗,三甲医院重点向救治疑难急重症患者转变;取消药品加成后医药分开效果显著,患者医药费负担明显下降;医院收入结构实现调整,技术劳务收入的提高有助于提高医务人员积极性,促使医院调整收入结构,加强精细化管理。

Objective To analyze the operation and effect of the medical separation comprehensive reform on a Three A and Tertiary Hospital in Beijing in the past two years.Methods The medical data of two years before reform(April 8 th,2015 to April 7 th,2016),one year before reform(April 8 th,2016 to April 7 th,2017),one year after reform(April 8 th,2017 to April 7 th,2018)and two years after reform(April 8 th,2018 to April 7 th,2019)were compared by self-control method in the same period,and the cross period changes were paired t-test.Analyze the operation and reform effect of the hospital in terms of medical service,drug use and income structure.Results After the reform,the number of outpatient(emergency)visits decreased by 12.57%,the number of discharged patients increased by 17.34%,the medical income increased steadily,the proportion of drugs decreased by 35.84%,the average drug cost per outpatient visit and the average drug cost per discharge decreased by 32.10%and 25.61%,respectively,the difference was statistically significant.The proportion of large-scale equipment inspection revenue decreased by 5.89%,and the proportion of technical labor revenue increased by 28.76%.Conclusions The comprehensive reform of medical separation realized the hierarchical diagnosis and treatment of medical institutions,and the Three A and Tertiary Hospitals focus on the difficult and urgent patients;the effect of medical separation was significant after the cancellation of drug addition,and patients’medical expenses was significantly reduced;the adjustment of hospital income structure and the increase of technical service income helped to improve the enthusiasm of medical staff,promote the hospital to adjust the income structure and strengthen the refinement administration.