北京市公立医院综合改革对医疗机构技术劳务收入的影响分析

Impacts of comprehensive reforms of public hospitals on technical service income across healthcare institutions in Beijing

目的:分析北京市医药分开和医耗联动综合改革对不同级别医疗机构体现医务人员技术劳务价值收入部分的影响。方法:利用参与北京市医药分开和医耗联动综合改革363家公立医疗机构2016年1月—2019年12月的监测数据,采用描述性分析结合多重间断时间序列模型,对改革前后不同级别医疗机构技术劳务收入及其占比的变化情况进行分析。结果:医药分开综合改革实施后,三级医院、二级医院、一级医院及社区的技术劳务收入较改革前分别增长了105.4%、119.7%和318.3%,其占比分别增长了5.91、6.44和5.87个百分点;医耗联动综合改革实施后,三级医院、二级医院、一级医院及社区技术劳务收入较改革前分别增长了26.2%、18.3%和11.6%,其占比分别增长了2.31、2.03和0.84个百分点。结论:北京市两项公立医院综合改革的实施有效促进了各级别医疗机构技术劳务收入的增长,医疗费用结构得到优化。建议进一步建立科学合理的医疗服务价格定价及动态调整机制,加强对基层医疗机构的重视,健全医疗服务行为监管体系。

Objective:To analyze the impact of the comprehensive reforms of medical-pharmaceutical separation and medical-consumables linkage reforms on health workers’income that reflects their technical services across healthcare institutions at different levels in Beijing.Methods:Monitoring data of the comprehensive reforms made during the period from January 2016 to December 2019 were collected from 363 public healthcare institutions in Beijing.Descriptive analysis and multiple Interrupted Time Series(ITS)model were used to analyze the change of technical services income and its proportion in total medical income after the implementation of the comprehensive reforms.Results:After implementing the comprehensive reform of medical-pharmaceutical separation,the technical services income increased by 105.4%,119.7%and 318.3%,respectively,among tertiary hospitals,secondary hospitals,primary hospitals and community health service centers.Out of the total medical income,the technical services income proportion increased by 5.91,6.44 and 5.87 percentage points,respectively.After implementing the comprehensive reform of medical-consumables linkage reforms,the technical services income increased by 26.2%,18.3%and 11.6%,respectively,among tertiary hospitals,secondary hospitals,primary hospitals and community health service centers.Out of total medical income,the technical services income proportion increased by 2.31,2.03 and 0.84 percentage points,respectively.Conclusions:The implementation of two comprehensive reforms of public hospitals in Beijing has effectively promoted the growth of technical service income of healthcare institutions at all levels in Beijing,and the structure of medical expenses was optimized.It is suggested to establish a scientific and reasonable pricing and dynamic adjustment mechanism of medical services;put more emphasis on primary healthcare institutions;and improve the supervision system of medical service behaviors.