取消药耗加成及按病种分值付费对公立医院运营的影响——以广州市某医院为例

Study on influence of cancelling drug and consumables price addition and payment by disease score on public hospital operation--Take a public hospital in Guangzhou for example

[目的]分析取消药品、耗材加成和按病种分值付费对公立医院运营的影响,为公立医院后续改革提供参考。[方法]选取2016-2019年各年的下半年(分别对应医改前、取消药品加成后、按病种分值付费后和取消耗材加成后)的相关数据,对医疗服务量、服务效率和住院费用进行对比分析,对医疗收入采用结构变动度分析。[结果]与医改前相比,医改后除普通门诊人次下降外,其余服务量和服务效率均提高,次均住院费用增长平稳,自付比例下降。药品收入占比下降10.22%。技术劳务性收入占比上升8.13%。[结论]改革后医院总体运行平稳,住院费用增长得到控制,医疗收入结构大致优化,但仍需完善药耗使用和医保结算管理,调整医疗服务价格,提高信息服务和监管水平。

Objective To analyze the impact of cancelling drug and consumables price addition and payment by disease score on public hospital operation so as to provide reference for follow-up reform of public hospitals. Methods Data of the second half of each year from 2016 to 2019( before the medical reform, after cancelling drug price addition, after the payment by disease score and after canceling consumables price addition) were selected. Comparative method was used to analyze medical service volume, service efficiency, and hospitalization expenses. Degree of structure variation was used to analyze medical income. Results After the medical reform, except for the decrease in the number of general out-patient visits, the medical service volume and efficiency had increased. Per average hospitalization expenses increased steadily and the proportion of self-payment decreased. The proportion of drug income decreased 10.22%. The proportion of technical labor income increased 8.13%. Conclusions After the medical reform, hospitals run normally. The increase in hospitalization expenses has been controlled, and the income structure has been roughly optimized. However, it is still necessary to improve the use of drugs and consumables and the management of medical insurance settlement, adjust the price of medical services, and improve the level of information services and supervision.