北京市医药分开、医耗联动综合改革对住院费用及结构的影响研究——基于T医院的实证分析

Research on the influence of comprehensive medical-pharmaceutical separation and medical-consumables linkage reforms on hospitalization expenses and structure in Beijing:Based on the empirical analysis of T hospital

目的:研究北京市医药分开综合改革、医耗联动综合改革对住院患者医疗费用及结构产生的影响。方法:利用北京市T医院两次改革前后的住院患者医疗费用数据,构建多断点回归模型。结果:北京市两次公立医院综合改革有效控制了住院患者费用的增长趋势,优化了医疗服务比价关系,医药分开改革降低了药占比和耗材比,医耗联动改革显著降低了耗材比。结论:北京市两次公立医院改革成效显著,但医疗服务人员劳动技术价值有待进一步提升,降低药品耗材费用仍是北京市未来公立医院费用改革的重点,通过推动DRGs和公立医院绩效改革可以有效调整控费措施对医疗保障水平的影响。

Objective:To study the impact of Medical and Pharmaceutical Separation(M-PS)Reform and Medical and Consumables Linkage(M-CL)Reform on the medical expenses and structure of medical expenses for inpatients in Beijing.Methods:The medical cost data of inpatients before and after the two reforms in the T hospital in Beijing were used to construct a RD treatment effect estimated with multiple cutoffs also termed as the multi-cutoff regression discontinuity design.Results:The two comprehensive reforms of public hospitals in Beijing have effectively controlled the increase in hospitalization expenses and optimized the price-performance ratio of medical services.The M-PS Reform reduced the proportion of medicines and the ratio of medical consumables,while the M-CL Reform significantly reduced the ratio of medical consumables.Conclusions:The two public hospital reforms in Beijing have achieved remarkable results,but the labor and technical income of medical service workers need to be further improved.It is thus suggested that reducing the cost of medicines and medical consumables should be the main focus of future public hospital reforms in Beijing.Therefore,through the promotion of DRGs reform and public hospital performance reform,the impact of medical cost control measures on the level of medical services can be effectively reduced.