药品零加成政策对住院费用的影响

Based on the Perspective of Hospitalized Cases to Analysis the Effect of Zero Price Addition Policy on the Hospitalization Expense

目的了解取消药品加成,调整医疗服务价格等卫生改革政策实施对住院费用及个人疾病负担的影响,为进一步推进城市公立医院补偿机制改革提供参考。方法运用一般性统计描述和Kruskal-Wallis秩和检验对政策实施前后(2017年8月1日前后各一年时间段)的住院总费用、个人疾病负担进行对比分析,运用卡方检验对费用结构进行差异分析。结果内科病种人均总费用降低10%左右,外科病种人均总费用变化不大;城镇职工医保的个人自付比例增加1~3个百分点,城乡居民医保的个人自付比例减少1个百分点左右;费用结构中,药品比例降低10%-13%,手术治疗费和材料费用占比均不同程度增加。结论尽管政策实施使总费用有所降低,但个人负担还与疾病类型、费用结构等密切相关,所以预期降低个人疾病负担的效果被稀释。城市公立医院须继续探索优化费用结构、切实降低患者经济负担的新途径。

Objective To explore the impact of the implementation of health reform policies such as zero price addition policy and adjusting the price of medical services on hospitalization expenses and personal disease burden,promote the reform of compensation mechanism in urban public hospitals.Methods The hospitalization expense and personal disease burden of common diseases before and after the implementation of zero price addition policy(One-year period before and after August 1,2017)were compared and analyzed by general statistical description,and the influence of policy implementation on hospitalization expense and personal burden was further discussed by non-parametric test.Results The expenditure of medical diseases decreased about 10%,while the surgical diseases changed little.The proportion of out-of-pocket expenses for urban and rural employees increased 1-3%,and the proportion of out-of-pocket expenses for urban and rural residents decreased about 1%.In the cost structure,the proportion of drugs decreased 10%-13%,and the proportion of surgical treatment cost and material cost also increased.Conclusions The total expenses showed a downward trend,but the personal economic burden was closely related to the type of disease and the cost structure.So the expected effect of reducing individual disease burden is diluted.Urban public hospitals should continue to explore new ways to optimize the cost structure and effectively reduce the economic burden of patients.