地市级公立医院医药价格改革运行现状研究

Research on the Current Situation of Medical Price Reform and Operation in Prefecture-level Public Hospitals

目的对地市级公立医院药品零差率销售改革情况进行跟踪调研,评价不同阶段性实施效果,为深化和完善医药价格体制改革补充机制提供参考。方法选取2018年1月—2019年12月市级5家医院相关医药价格改革前后运营指标,运用对比研究方法进行改革效果研究。结果样本医院医疗服务收入占比增长,药占比有所下降,运行正常;门诊和住院次均费用不同程度增长;医疗服务价格调整未能有效弥补减少的合理收入,传统内科、肿瘤专科受冲击大。结论落实政府办医主体责任,增加政府财政投入;逐步建立有利于费用控制、以合理成本定价为基础的医疗服务价格动态调整机制;完善医务人员绩效激励机制;探索政府财政对公立医院分类补偿办法;推动DRG付费改革,减少患者的医疗费用负担。

Objective To follow up and investigate the zero-markup sales reform of medicines in public hospitals at prefecture and city level,to evaluate the effects of implementation in different stages,and to provide references for deepening and perfecting the supplementary mechanism of the medical price system reform.Methods Select the operating indicators before and after the medical price reform of 5 municipal hospitals from January 2018 to December 2019,and use comparative research methods to study the reform effect.Results The proportion of medical service income in the sample hospitals increased,the proportion of medicines declined,and the operation was normal;the average cost of outpatients and hospitalizations increased to varying degrees;the price adjustment of medical services failed to effectively compensate for the reduced reasonable income,and traditional internal medicine and oncology specialists were affected largely.Conclusion Implement the main responsibility of the government to run medical services and increase government financial input;gradually establish a dynamic adjustment mechanism for medical service prices that is conducive to cost control and based on reasonable cost pricing;improve the performance incentive mechanism for medical staff;explore government financial compensation methods for public hospitals;promote the DRG payment reform to reduce the burden of patients'medical expenses.