我国136家三级公立医院实施药品零差率政策及经济运行情况分析

Implementation of Zero Mark-up Medicines Policy and Economic Performance Analysis of 136 Chinese Tertiary Public Hospitals

目的:了解我国三级公立医院实施药品零差率政策后的经济运行情况。方法:基于五次全国“进一步改善医疗服务行动计划”第三方评估核心样本医院的机构调查,采用描述性统计分析方法,描述样本医院总体及不同地区、不同类型样本医院的药品、医疗服务和财政补助收入及其占比在实施药品零差率政策后的变化,及样本医院的收入结构变动度和亏损情况。结果:2014~2020年,样本医院各年度相比前1年的年均药品收入结构变动值均为负值。药品收入变化对收入结构变动的贡献率最高,达到51.98%。2015~2017年,多数样本医院开始实施药品零差率政策,亏损面达25%以上。2018~2020年,各类别样本医院的年均药品收入占比仍持续降低。结论:样本医院实施药品零差率后,药品收入增速得到控制,药品收入占比降低是收入结构变化的最主要影响因素,但收支缺口未补偿到位,新的补偿机制有待健全。

Objective:To learn the economic performance of tertiary public hospitals after implementation of the zero mark-up medicines policy.Methods:The descriptive analysis was used to summarize the overall changes of medicines,medical services and government subsidy revenues and their proportions in 136 sample hospitals after implementation of the zero mark-up medicines policy.The above changes of sample hospitals in different regions and different types of sample hospitals,as well as the revenue structural variability and economic loss of 136 sample hospitals were also analyzed.The study was based on the facility surveys of five rounds of national external evaluations of healthcare improvement initiative.Results:The changes of proportional medicines revenue between the adjacent two years during 2014-2020 were all negative.Changes of proportional medicines revenue was the biggest contributor of income structure change which reached 51.98%.From 2015 to 2017,most of sample hospitals started to implement the zero mark-up medicines policy,over 25%of them experienced economic loss.The proportional medicines revenue of all type of sample hospitals continuously decreased during 2018 and 2020.Conclusion:After implementation of the zero mark-up medicines policy,the growth rate of revenue generated from medicines was contained,and the reduction of the proportionate revenue generated from medicines was the most important contributor to the change of revenue structure.There were still gaps between the reduction of revenue generated from medicines and the increase of revenue generated from medical services plus government subsidies.The new compensation mechanism of public hospitals is still to be improved.