医药价格综合改革对公立医院医疗收入总额及结构的影响

Influence of Comprehensive Medicine Price Reform on Total Medical Income and Structure of Public Hospitals

目的:探究医药价格综合改革对医院医疗收入总额及结构的影响。方法:将本市某三甲医院实施医药价格综合改革前(2017年-2018年)的医疗收入情况作为对照组资料,实施医药价格综合改革后(2019年-2020年)的医疗收入情况作为研究组资料。以因素连环替代法对改革实施后医疗收入总额的变化进行分析,以结构变动度分析法对改革实施后医疗收入结构的变化进行分析。结果:该院在实施药品“零加成”改革后,研究组的医疗收入总额较对照组同比增加26.23%。在收入结构方面,研究组门诊收入较对照组同比增长16.43%,住院收入较对照组同比增长29.24%;患者数量、单次诊费均值的增长率对门诊收入增加值的贡献增长率分别为92.68%、7.32%,对住院收入增加值的贡献增长率分别为77.00%、23.00%;药品收入在门诊和住院收入中的结构变动度最大。在门诊收入结构变动中,药品、化验、检查、手术收入是主要影响因素;在住院收入结构变动中,药品、治疗、手术、护理收入是主要影响因素。结论:医药价格实施综合改革之后,医院运营情况整体平稳,在门诊收入、住院收入增加的影响因素中,患者数量增加是主要因素,但药品收入在门诊和住院收入中的占比均下降,治疗占比、医务人员技术劳务占比均提高,医疗收入结构在改革后有所优化。

Objective: The paper is to explore the impact of comprehensive medical price reform on total medical income and structure of hospitals. Methods: The medical income before the comprehensive reform of medical price(2017-2018) was taken as the control group, and the medical income after the comprehensive reform of medical price(2019-2020) was taken as the research group. The change of total medical income after the implementation of the reform is analyzed by interlocking substitution, and the change of medical income structure after the implementation of the reform is analyzed by degree of structure variation. Results: The total medical income of the research group increased 26.23% compared with that of the control group after the implementation of the drug "zero plus" reform. In terms of income structure, the outpatient income of the study group increased by 16.43% and the inpatient income by 29.24% compared with the control group. The growth rates of the number of patients and the average cost per visit contributed 92.68% and 7.32% to the added value of outpatient income, and 77.00% and 23.00% to the added value of inpatient income respectively. The structural variation of drug income in outpatient and inpatient income was the greatest. In the change of outpatient income structure, medicine, laboratory,examination and operation income are the main influencing factors while in the change of inpatient income structure, medicine, treatment, operation and nursing income are the main influencing factors. Conclusion: After the implementation of comprehensive medicine price reform, the hospital operated well. Among the influence factors of outpatient and inpatient income, the increase in the number of patients was the main factor, but the proportion of drug income in the outpatient and inpatient income, decreased, the proportion of treatment and medical personnel’s skill increase, and medical income structure has been improved after the reform.