城市公立医院取消药品加成前后经济运行情况对比分析——以昆明地区地市级及以上公立医院为例

Comparative analysis on economic operation of public hospitals before and after the abolition of drug price addition in Kunming

[目的]分析昆明地区地市级及以上城市公立医院取消药品加成前后经济运行情况,为城市公立医院改革提供参考建议。[方法]采用统计描述和对比分析,对昆明地区20所地市级及以上城市公立医院取消药品加成前(2016年)与取消药品加成后(2018年)的总收入、总支出、医疗收入、业务支出及长期负债结构进行分析。[结果]取消药品加成前后,总收入均大于总支出,收支均有结余。①收入:总收入中财政补助收入占比从2016年的7.5%下降到2018年的6.7%;医疗收入中药品收入占比从2016年的41.4%下降到2018年的33.3%,医疗服务收入占比从2016年的22.3%增加到2018年的25.0%。②支出:业务支出中人员支出占比从2016年的33.2%增加到2018年的34.6%;药品耗材支出占比从2016年的54.0%降低到2018年的52.7%。③负债:长期负债从2016年的14.7亿元减少到2018年的9.4亿元,85%以上的长期负债是由基本建设、设备购置负债形成。[结论]取消药品加成后医院总体经济运行平稳,药品收入占比降低,医疗服务收入占比逐步增加,符合城市公立医院改革的政策要求。但还存在财政投入相对不足、医疗服务价格调整不到位、长期负债难以化解、人员支出与药品耗材支出占比倒挂等问题。

Objective To analyze economic operation of prefecture-level and above urban public hospitals before and after the abolition of drug price addition in Kunming so as to provide reference and suggestion for the reform of urban public hospitals. Methods Statistical description and comparative analysis were used to analyze total income and expenditure, medical income, business expenditure and long-term debt structure of 20 prefecture-level and above urban public hospitals in Kunming before(2016) and after(2018) the cancellation of drug price addition. Results Before and after the cancellation of drug price addition, total income was higher than total expenditure, and there was a balance in both accounts. 1. Income category: the proportion of financial subsidies in total revenue decreased from 7.5% in 2016 to 6.7% in 2018;the proportion of pharmaceuticals in medical income decreased from 41.4% in 2016 to 33.3% in 2018, the proportion of medical service income increased from 22.3% in 2016 to 25.0% in 2018. 2. Expenditure category: the proportion of personnel expenditure in business expenditure increased from 33.2% in 2016 to 34.6% in 2018;the proportion of pharmaceutical consumables expenditure decreased from 54.0% in 2016 to 52.7% in 2018,3. Liabilities: long-term liabilities decreased from 1.47 billion yuan in 2016 to 940 million yuan in 2018, over 85% of long-term liabilities were formed by the liabilities for capital construction and equipment acquisition. Conclusions After the abolition of drug price addition, overall economic operation of hospital is stable, the proportion of drug income reduces, and the proportion of medical service income gradually increases, which is in line with the policy requirements of urban public hospital reform. However, there are still some problems such as insufficient financial input, inadequate medical service price adjustment, difficult to resolve long-term liabilities, hanging upside down of personnel and drug consumables expenditure.