药品零差率改革对公立医院医疗成本及结构的影响分析

Analysis of the impact of drug zero-markup reform on medical cost and structure in public hospitals

目的:分析比较药品零差率改革前后A市公立医院医疗成本及其成本要素变化趋势,为深化医改提供参考。方法:利用A市21所公立医院成本核算数据,运用描述性方法比较分析药品零差率改革前后医疗成本及其成本要素绝对规模和相对规模。结果:药品零差率改革后,全市公立医院医疗成本较改革前增加34.71%,其中人员经费占比和卫生材料费分别增加2.58%和2.01%,药品费占比减少5.28%。药品零差率改革拉大了不同类型医院人员经费和药品费占比差异,缩小了卫生材料费、固定资产折旧、无形资产摊销、提取医疗风险基金和其他费用占比差异。结论:药品零差率改革显著提升了公立医院的人力价值;卫生材料费是公立医院成本转嫁行为的重点监控领域;不同类型公立医院医疗成本结构出现分化,精益化管理能力存在差异。

Objective: To analyze and compare the trend of medical cost and cost factors in public hospitals in city A before and after the drug zero-markup reform, and to provide reference for deepening the medical reform.Methods: Using the cost accounting data of 21 public hospitals in city A, descriptive methods were used to compare and analyze the absolute scale and relative scale of medical costs and their cost elements before and after the drug zeromarkup reform. Results: After the reform of the zero-markup rate of drugs, the medical cost of public hospitals in the city increased by 34.71% compared with that before the reform, of which the proportion of personnel expenses and the cost of health materials increased by 2.58% and 2.01% respectively, and the proportion of drug expenses decreased by 5.28%.The drug zero-markup reform has widened the differences in the proportions of different types of hospital personnel expenses and drug expenses, and narrowed the differences in the proportions of health materials expenses, depreciation of fixed assets, amortization of intangible assets, withdrawal of medical risk funds and other expenses. Conclusion:The drug zero-markup rate reform has significantly improved the human value of public hospitals;the cost of health materials is the key monitoring area of public hospitals? cost-shifting behavior;the medical cost structure of different types of public hospitals is differentiated, and there are differences in lean management capabilities.