取消药品加成后医疗服务价格调整对住院费用影响分析

Analysis of the impact of medical service price adjustment on hospitalization expenses after removing medicine makeups

目的分析取消药品加成及两轮医疗服务价格调整改革对住院患者费用的影响,并为政策制定和医院经营战略的调整提供参考依据。方法选取案例医院病案管理系统2016年—2018年的病案首页数据。根据调整政策时间将医院病案管理系统病案首页数据分为2组,包括政策实施前(2016年)和政策实施后(2017年—2018年)。采用中断时间序列(interrupted time series,ITS)分析政策实施前后住院费用的变化情况。结果政策实施前,2016年住院平均费用为(17863.35±334.73)元;政策实施后,2017年住院平均费用为(18066.16±398.42)元,2018年住院平均费用为(18238.95±258.28)元。ITS分析显示,在政策实施前,患者的平均住院费用每个月增加26.616元,但无统计学意义(P=0.323);政策实施当月(2016年12月),患者平均住院费用减少141.212元,但无统计学意义(P=0.547);政策实施后,患者平均住院费用斜率为22.363,患者住院费用呈上升趋势,但无统计学意义(P=0.881)。3年间药品费用下降了13.64%,材料费用下降了3.69%,劳务性费用上升了12.25%。结论取消药品加成及两轮医疗服务价格调整改革后,患者住院期间的药品费用、材料费用下降,劳务性费用提高,而患者的住院费用没有变化。

Objective To analyze the impact of removing medicine makeups and two rounds of medical service price adjustment reform on inpatient expenses,and to provide reference for policy-making and adjustment of hospital management strategy.Methods Select the front page data of medical records of the case hospital medical record management system from 2016 to 2018.According to the time of cancellation of drug addition and two rounds of medical service price adjustment reform,the data on the first page of medical records in the hospital medical record management system are divided into two groups,including before the implementation of the policy(2016)and after the implementation of the policy(2017-2018).Interrupted time series(ITS)was used to analyze the changes of hospitalization expenses before and after the adjustment of the policy.Results Before the implementation of the policy,the average hospitalization expenses in 2016 was(17863.35±334.73)yuan;After the implementation of the policy,the average hospitalization expenses in 2017 was(18066.16±398.42)yuan,and the average hospitalization expenses in 2018 was(18238.95±258.28)yuan.ITS analysis showed that before the implementation of the policy,the average hospitalization expenses of patients increased by 26.616 yuan per month,but there was no statistical significance(P=0.323).In the month when the policy was implemented(December 2016),the average hospitalization expenses of patients decreased by141.212 yuan,but there was no statistical significance(P=0.547).After the implementation of the policy,the slope of average hospitalization expenses of patients 22.363,and the inpatient expenses showed an upward trend,but there was no statistical significance(P=0.881).In the past three years,the drug expenses has decreased by 13.64%,the material expenses has decreased by 3.69%,and the labor expenses has increased by 12.25%.Conclusions After the removing medicine makeups and two rounds of medical service price adjustment reform,the drug expenses and material expenses decreased during hospitalization,and the labor expenses increased,but no change in hospitalization expenses.