取消药品加成对公立医院住院服务绩效的影响

The Effect of Drug Make-up Cancellation on Inpatient Service Performance in Public Hospitals

目的了解取消药品加成政策实施对广州某三甲医院住院医疗服务绩效的影响,为城市公立医院改革的深入开展和完善提供参考。方法采用CN-DRGs分组器进行分组,选取广州某三甲综合医院取消药品加成改革前2017年2月1日-6月30日和改革后2017年8月1日-12月31日出院患者的住院病案首页,分析比较政策实施前后不同ADRG组的住院服务绩效各项指标变化情况。结果改革后,医院整体总权重增长9.21%,其中CMI上升1.28%,入组人数上升7.83%;住院天数缩短0.21天和时间消耗指数下降2.09%;总费用显著上涨,药占比和耗材占比显著降低(P<0.05),且药品消耗指数降低13.1%。非手术操作组的总权重增长18.02%,药品消耗指数降低21.61%;分组分析后,外科组总费用显著升高(P<0.001);非手术操作组耗材占比显著降低(P<0.001),且总权重上升18.02%;内科组的住院天数显著缩短(P<0.001),且药品消耗指数下降12.22%。结论广州市取消药品加成后,医院住院服务能力有所提升,周转效率加快,有效控制了药占比和耗材占比,优化费用结构。但对总费用的控制仍需加强,尤其是外科组应重点关注。

Objectives To investigate the effect of canceling the drug make-up policy on the inpatient medical service performance of a Three A and Tertiary hospital in Guangzhou and provide reference for the in-depth development and improvement of urban public hospital reform.Methods CN-DRGS was used for grouping.The front page of inpatient medical records of patients in a Three A and Tertiary Hospital in Guangzhou from February 1st to June 30th,2017 before the drug make-up reform was canceled and from August 1st to December 31st,2017 after the reform were selected.The changes of indexes of inpatient service performance in different ADRG groups before and after the policy implementation were analyzed and compared.Results After the reform,the overall weight of the hospital increased by 9.21%,CMI increased by 1.28%,and the number of enrolled increased by 7.83%.The length of hospital stay was reduced by 0.21 and the time consumption index was decreased by 2.09%.The total cost was significantly increased,the drug proportion and consumable proportion were significantly decreased(P<0.05),and the drug consumption index was decreased by 13.1%.The total weight of non-surgical operation group increased by 18.02%,and the drug consumption index decreased by 21.61%.After grouping analysis,the total cost of surgery group was significantly increased(P<0.001);The proportion of consumables in non-surgical operation group was significantly decreased(P<0.001),and the total weight increased by 18.02%;In the internal medicine group,the length of hospital stay was significantly shortened(P<0.001),and the drug consumption index was decreased by 12.22%.Conclusions After the abolition of drug make-up in Guangzhou,the inpatient service capacity was improved,the turnover efficiency was accelerated,the drug ratio and consumable ratio were effectively controlled,and the cost structure was optimized.However,the control of the total cost still needed to be strengthened,especially in the surgical group.