取消药品与医用耗材加成相关政策对公立医院经济的影响

The impact of canceling drug and medical consumables addition policy on the finance of public hospitals

目的:通过跟踪调查RJ医院实施取消药品加成、降低医用耗材加成及部分医疗服务价格调整政策后收入结构以及患者医疗负担变化,分析取消药品与医用耗材加成相关政策对公立医院经济的影响。方法:按中断时间序列分析法对收入结构和补偿率进行水平变化和趋势变化测评,并运用数据库和逻辑检验分析等方法对数据进行筛选。结果:药占比及医保患者自付比例呈下降趋势,医院综合补偿率达到65%,补偿水平较为稳定;技术劳务性收入占比仍然较低,卫生材料收入占比略有提高。结论:取消药品加成、降低医用耗材加成以及医疗服务价格调整相关政策是降低就医负担、优化医院收入结构的有效途径,然而还需通过建立动态调价机制、强化分级诊疗、创新供应管理模式、推进全面预算等措施优化医院经济结构,保障公立医院健康稳定发展。

Objectives: To follow up and investigate the changes of income structure and patients’ medical burden after RJ Hospital implementing the policy of canceling drug additions, reducing the additions of medical consumables and adjusting the prices of some medical care. Methods: The interruption time series analysis(ITS) method was adopted to evaluate the level and trend changes of income structure and compensation rate. The data were filtered by using database and logical test analysis. Results: The proportion of medicine income and self-payment of medical insurance patients showed a downward trend. The comprehensive compensation rate reached 65%, and the level of compensation was relatively stable. However, the proportion of technical labor income was still low, and the proportion of medical consumables income increased slightly. Conclusions: Cancellation of drug additions, reduction of medical consumables additions and adjustment of medical service prices are effective ways to reduce the burden of medical treatment and optimize the income structure of hospitals. However, it is necessary to establish dynamic price adjustment mechanism,strengthen graded diagnosis and treatment, innovate supply management mode, and promote comprehensive budget management, so as to ensure the healthy and stable development of public hospitals.