基于双重差分模型的公立医院医疗服务价格改革政策效应实证分析

Empirical analysis on policy effect of medical service price reform in public hospitals based on difference-in-difference model

[目的]评估公立医院医疗服务价格改革的政策效应,以期为进一步深化公立医院医疗服务价格改革提供参考。[方法]通过函询发文的形式,收集广东省318家公立医院的基本医疗服务价格调整政策评价相关数据,通过描述性统计和固定效应面板模型分析医疗服务价格改革政策影响。[结果]改革后,试点医院的次均药品成本降低52.34元,药品成本占总医疗业务成本的比重下降2.52%,药占比降低3.77%,检查化验收入占比增加4.23%,差异均具有统计学意义。次均住院费用虽然减少了393.85元,但差异无统计学意义。医师日均诊疗人次增加3.11人次,但平均住院日和床位周转次数差异无统计学意义。[结论]医疗服务价格改革政策对控制药品成本、降低药品费用具有正向效应,但收入结构优化不明显,次均住院费用降低较少,并且对工作量及服务效率产生的效应有限,甚至是负向效应。建议建立医疗服务价格动态调控管理体系、改革公立医院补偿机制、动态调整医保支付水平、创新公立医院薪酬分配制度、强化综合监管等措施协同改革。

Objective To evaluate policy effect of medical services price reform in public hospitals so as to provide reference for further deepening medical services price reform in public hospitals.Methods Through letter inquirement and document,it collected relevant data of basic medical services price adjustment policy evaluation in 318 public hospitals in Guangdong Province,analyzed policy impact of medical service price by descriptive statistics and fixed-effect panel models.Results After the reform,per average drug cost in the pilot hospitals reduced by 52.3434 yuan,the proportion of drug costs in total medical business cost decreased by 2.52%,the proportion of drugs decreased by 3.77%,and the proportion of inspection and laboratory income increased by 4.23%.There was statistical significance in differences.Although per average hospitalization cost had been reduced by 393.8527 yuan,there was no statistical difference.Person-time of average daily diagnosis and treatment for the physician increased 3.11,but there was no statistical in difference of average hospitalization days and number of bed turnover.Conclusions The medical service price reform policy has positive effect on controlling the cost of medicine and reducing medicine expenditures,but the optimization of income structure is not obvious,per average hospitalization cost decrease less,and the effect on workload and service efficiency is limited or even is negative effect.It is recommended to establish dynamic control and management system for medical service prices,reform the compensation mechanism of public hospitals,dynamically adjust the level of medical insurance payment,innovate the salary distribution system of public hospitals,and strengthen comprehensive supervision.