北京市医药分开背景下医院住院患者就医行为及费用变化趋势分析

Analysis of the Change of Inpatient Behavior and Expense in a Hospital under the Background of Separation between Medical and Pharmaceutical Services in Beijing

目的通过分析医药分开前后患者就医行为、住院费用的变化及其机制,为医药分开改革政策的进一步完善提供依据。方法采取静态比较分析法,按照DRGs分组选取某三甲医院病例数最多的前五组,对医药分开综合改革前后住院患者的诊疗人次、住院天数、出院次数、次均费用及费用构成等指标进行比较分析。结果医药分开改革后,不同分组患者的就医行为和费用的变化均不相同;药品费用、检查费用和材料费用有所下降,最大降幅分别达到36.26%、15.52%、27.79%;综合服务费和治疗费用则存在一定程度的上涨。结论医药分开改革对患者就医行为有一定的引导作用,也在一定程度上改变了原来不合理的价格形成机制,使医务人员的劳动价值得到体现,但医院仍需进一步加强费用管理,建立有效的补偿机制。

Objective To improve the reform policy of Separation between medical and pharmaceutical services by analyzing the change and mechanism of patients'medical treatment behavior and hospitalization expense before and after the reform.Methods The first 5 groups with the largest number of cases were selected according to the DRGs group by the comparative static analysis method,and the indexes such as diagnosis and treatment time,length of stay,discharge times,average cost per time and cost composition before and after the comprehensive reform of separation between medical and pharmaceutical Services were compared and analyzed.Results After the reform of separation between medical and pharmaceutical Services,different groups of patients had different changes in the behavior and cost of medical treatment;In terms of cost composition,drug cost,examination cost and material cost had decreased,while comprehensive service cost and treatment cost had increased to some extent.Conclusion The reform of separation between medical and pharmaceutical Services has a certain guiding effect on patients'medical treatment behavior,and also changes the original unreasonable price formation mechanism to some extent,so that the labor va-lue of medical staff can be reflected.However,hospitals still need to further strengthen cost management,and establish an effective compensation mechanism.