基于灰色关联和结构变动度的公立医院住院费用构成分析

Analysis on the composition of hospitalization expenses in public hospitals based on grey correlation and structural change degree

[目的]对国内公立医院住院医疗费用构成情况进行分析,探讨住院费用的影响因素,为促进公立医院高质量发展,制定宏观政策提供参考。[方法]利用灰色关联分析法和结构变动度分析法综合分析2012-2020年我国公立医院患者住院医疗费用的影响因素及构成变动趋势。[结果]2012-2020年我国住院费用波动变化总体呈上升趋势,但增速放缓。灰色关联度分析显示,各项住院费用与总费用的关联度的排序依次是药费、卫生材料费、其他费用、治疗费、检查费、手术费、床位费和护理费。结构变动度分析结果显示,2012-2020年我国住院费用结构变动度为29.42%,结构变动贡献率最大的是药费(52.12%),其次是卫生材料费(27.32%)。[结论]医改以来公立医院综合改革取得了较大成效,在控制住院费用增长过快方面取得了一定成效,但还需继续完善政策引导,持续加强对药品和耗材的监管,提高技术劳务价值,建立科学的薪酬机制,进一步调整医药费用结构,使公立医院回归公益性。

Objective This paper analyzes the composition of inpatient medical expenses in domestic public hospitals, and discusses the influencing factors of inpatient expenses, so as to provide reference for further promoting the high-quality development of public hospitals and macro policy-making. Methods The influencing factors and composition change trend of inpatient medical expenses in public hospitals from 2012 to 2020 were comprehensively analyzed by grey correlation analysis and structural change analysis. Results From 2012 to 2020,the hospitalization expenses fluctuated and generally showed an upward trend, but the growth rate slowed down. The grey correlation analysis showed that the related of each hospitalization expense and total expenses was the order of medicine expenses, health material expenses, other expenses, treatment expenses, examination expenses, operation expenses, bed expenses and nursing expenses. The results of structural change analysis showed that the structural change of hospitalization expenses in China from 2012 to 2020 was 29.42%,and the largest contribution rate of structural change was the cost of drugs(52.12%),followed by the cost of health materials(27.32%). Conclusions Since the medical reform, the comprehensive reform of public hospitals has made great achievements in controlling the excessive growth of hospitalization expenses. However, we still need to continue to improve the policy guidance, strengthen the supervision of drugs and consumables, improve the value of technical services, establish a scientific salary mechanism, further adjust the structure of medical expenses, and make public hospitals return to public welfare.