药品和耗材集中带量采购下的医疗服务项目补偿及卫生资源空间腾换研究

Study on Compensation of Medical Service Items and Space Vacating of Health Resources under Centralized Volume Purchase of Drugs and Consumables

目的:探索药品和高值耗材集中带量采购下,医疗项目的补偿率和医疗卫生资源的腾换空间。方法:选取某公立医院作为个案,采用2020年第2季度、2021年第2季度样本医院HIS和财务数据,全院汇总分析手术、非手术、医技3类项目的前50位的亏损情况。结果:样本医院2020年第2季度实施医疗项目共2398项,亏损率为54.88%;2021年第2季度实施医疗项目共2437项,亏损率为55.43%;且2020第2季度手术的“Y局部浸润麻醉、Y磨牙拔除术”等项目和非手术的“Y膀胱冲洗、二级护理”等10位亏损补偿率均小于3%。2021年第2季度补偿率虽仍小于3%,但前50项亏损项目排位有一定变化。结论:重庆市2019年医疗物价的调整对公立医院的医疗服务行为有一定的引导作用,在一定程度上将药品和高值耗材集中带量采购挤出的空间通过医疗服务价格调整腾换到医院和患者,但持续亏损的项目仍未因调整物价而改变;新增加的39个项目有一定亏损,将来在选择调整项目时仍需深化对补偿率的研究,为卫生资源空间腾换中的医疗物价动态调整机制提出量化建议。

Objective:To explore the compensation rate of medical items and the vacating space of medical and health resources under the centralized procurement of drugs and high-value consumables.Methods:Selecting a public hospital as a case,the hospital’s HIS and financial data in the second quarter of 2020 and the second quarter of 2021 are applied based on the collected data according to the hospital cost accounting responsibility center dictionary and business process,The whole hospital analysis of surgery,non-surgical,medical technology of the first 50 loss of the project were also calculated.Results:In the second quarter of2020,2398 medical items were carried out,including 1655 clinical items with a loss rate of 54.88%.There were 2437 medical items in the second quarter of 2021 with a loss rate of 55.43%.In the second quarter of 2020,the loss of 10 patients including"Y local infiltration anesthesia,Y molar extraction"and non-operative"Y bladder irrigation,secondary care"were all less than 3%.The 2021 second quarter CR is still less than 3%,but the first 50 loss items ranking has a certain change.Conclusion:The Chongqing 2019 medical treatment price adjutsment has a certain guiding effect on the medical service behavior of public hospitals,and focusing on patients’interests,to a certain extent,the space squeezed out by the centralized quantitative procurement of drugs and high-value consumables is freed up for hospitals and patients through the adjustment of medical service prices.However,persistent loss-making items remain unchanged by price adjustments.The addition of 39 items with some deficits suggests that there is still a need to deepen the study of compensation rates in the selection of adjustment items in the future,so as to make quantitative recommendations for the dynamic adjustment mechanism of medical prices in the spatial release of health resources.