药品零差率政策对山东省不同规模公立三甲医院收入影响的差异分析

Differential Analysis of the Impact of the Zero Markup of Drug Policy on the Income of Public Grade-A Tertiary Hospitals of Different Scales in Shandong Province

目的:研究药品零差率政策对山东省不同规模公立三甲医院收入影响的差异,为医院后续改革和发展提供参考。方法:将医院分为大、小规模,对15家公立三甲医院信息系统2013-2019年的面板数据进行多组别间断时间序列分析。结果:小规模医院更依赖门急诊收入,大规模医院更依赖住院收入。政策实施后,大规模医院创收能力更强,收入增长加快(37.45%,P<0.001),尤其是住院方面(31.69%,P<0.001);小规模医院的住院收入增长放缓,门急诊收入未受明显影响。结论:规模不同的医院受政策的影响存在差异,大规模医院的总收入增长更快,住院创收能力更强,小规模医院的门急诊收入未受到明显影响。后续改革应加强小规模医院服务能力建设;根据门诊、住院特点设定不同的考核方式;补偿政策重点放在价格改革,继续理顺医疗机构收入结构。

Objective:To explore the differences in the impact of the zero markup of drug policy on the income of public grade-A tertiary hospitals of different scales in Shandong province,so as to provide references for the subsequent reform and development of the hospitals.Methods:The hospitals were divided into large and small scale.The interrupted time series analysis of the panel data of information systems in 15 public grade-A tertiary hospitals from 2013 to 2019 was conducted.Results:Small-scale hospitals depended more on outpatient and emergency income and large-scale hospitals depended more on inpatient income.Large-scale hospitals had the greater income-generating capacity,the income increased rapidly(37.45%,P<0.001),especially in inpatient department(31.69%,P<0.001).The growth of inpatient income in small-scale hospitals slowed down,and outpatient and emergency income was not significantly affected.Conclusion:There are differences in the impact of policies on hospitals with different scales.The total income of large-scale hospitals increases faster and the inpatient income-generating capacity is stronger,while the outpatient and emergency income of small-scale hospitals is not significantly affected.In the future,the capacity building of small-scale hospitals should be strengthened.We should set different assessment methods based on outpatient and inpatient characteristics.The follow-up policy should focus on price reform and continue to rationalize the income structure of medical institutions.