医耗联动改革对精神疾病住院患者费用的影响及对策研究

Study on Impact of Medical-Consumption Linkage Reform on Cost of Hospitalized Patients with Mental Disorders and Countermeasures

目的分析北京市医耗联动综合改革对北京市某精神专科医院精神疾病住院患者主要病种费用的影响,提出对策。方法收集北京市某三级甲等精神专科医院精神疾病住院患者的病案首页数据,采用χ^(2)检验和t检验比较改革前后主要病种住院患者基本情况和医疗费用变化。结果改革前后主要病种住院患者在性别、年龄、医疗付费方式和平均住院日之间均无显著统计学差异;改革后平均住院费用增长、平均医疗服务费用增长、平均卫生材料费用下降,这三项费用的变化差异均有统计学意义,检查化验费用和药品费用的变化差异无统计学意义。结论医改提高了体现医务人员技术劳动价值的医疗服务费用,病种住院费用结构趋于合理,据此提出推进建立医疗服务价格动态调整机制、着力促进医院管理提质增效、探索建立医院绩效激励机制等管理建议。

Objective To analyze the impact of medical consumables linkage reform on the medical cost of main diseases of mental disease inpatients in a psychiatric hospital in Beijing,and to propose countermeasures.Methods The data of medical record first page of mental disease inpatients in a tertiary psychiatric hospital in Beijing were collected,χ^(2)test and t test were used to compare the general conditions and medical cost of inpatients with main diseases before and after reform.Results Before and after the reform,there were no statistically significant differences in the gender,age,medical payment method,and average length of stay of the inpatients with main diseases.After the reform,the average cost of hospitalization and medical services increased,and the average cost of medical consumables decreased,and the differences in these three items were statistically significant.However,there were no statistically significant differences in the cost of laboratory tests and drugs.Conclusion The medical reform has improved the cost of medical services that reflect the technical labor value of medical staff and made the structure of hospitalization cost more reasonable.It is suggested to establish a dynamic adjustment mechanism for medical service prices,focus on promoting the quality and efficiency of hospital management,and to explore a hospital performance incentive mechanism.