取消药品加成对四川省公立医院经济收入的影响
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摘要
目的:通过分析四川省取消"药品加成"政策前后全省公立医院经济收入的变化,为下一步政策的制定提供参考依据。方法:通过"四川省新一代卫生计生统计数据采集与决策支持系统",收集了全省397家公立医院从取消前(2016年1月-11月)和取消后(2017年1月-11月)两年的门诊、住院和药品收入占比等情况进行对比分析。结果:政策实施后,取消加成的药品品规数471种,占总药品品规数的97.04%,取消药品加成政策实施后门诊患者次均医疗费用为178.61元,较取消前的174.56元增长了2.32%;住院病人次均医疗费用为6357.78元较取消前的6055.06元增长了4.99%;门诊患者次均药费为66.93元,较取消前的66.17元增长了1.15%;住院患者次均药费1742.27元,较取消前的1747.71元降低了0.31%。调整后增加的医疗收入和政府财政补助远不及取消加成后减少的药品收入,缺口66147.37万元;全面取消药品加成后,门诊、住院药品收入占比均有所下降。结论:取消后门诊患者次均医药费和药费用略有增高,药品收入在门诊和住院收入中占比均有所下降,增加的收入和财政补助不能弥补取消药品加成后减少的药品收入。
Objective: To analyze the change after Cancellation of the"drug add-on"policy in Sichuan Province on the public hospitals,and to provide a reference for the formulation of the next policy. Methods: Through the "Sichuan New Generation Health and Family Planning Statistics Data Collection and Decision Support System",397 public hospitals in the province were collected from the cancellation(January to November 2016) and after cancellation(January to November 2017). The comparative analysis of outpatient,hospitalization and drug income in the year was conducted. Results: After the implementation of the policy,471 kinds of drug products were cancelled,accounting for 97.04% of the total drug regulations. The number of institutions setting up medical service fees,pharmacy service fees,and increasing the price of medical services increased significantly. After the implementation of the bonus policy,the average medical expenses for outpatients was 178.61 yuan,which was 2.32% higher than before the cancellation 174.56 yuan. The average medical expenses for inpatients was 6357.78 yuan,which was 4.99 percent higher than before the cancellation 6055.06 yuan. After the policy was abolished,the average drug cost for outpatients was 66.93 yuan,which was 1.15% higher than before the cancellation 66.17 yuan. The average drug cost for inpatients was 1742.27 yuan,which was0.31% lower than before the cancellation 1747.71 yuan. Medical income and government financial subsidies are far less than the reduction in drug revenues after the cancellation,with a gap of 66147.37 million after the total elimination of drug additions,the proportion of outpatient and inpatient drugs has declined. Conclusion: After the cancellation,the average medical and medical expenses of the outpatients increased slightly. There was a decline of the drug revenue ratio in the clinic and hospital income. The income and financial subsidies after the implementation of the policy were far less than the drug income after the drug was added.
Objective: To analyze the change after Cancellation of the"drug add-on"policy in Sichuan Province on the public hospitals,and to provide a reference for the formulation of the next policy. Methods: Through the "Sichuan New Generation Health and Family Planning Statistics Data Collection and Decision Support System",397 public hospitals in the province were collected from the cancellation(January to November 2016) and after cancellation(January to November 2017). The comparative analysis of outpatient,hospitalization and drug income in the year was conducted. Results: After the implementation of the policy,471 kinds of drug products were cancelled,accounting for 97.04% of the total drug regulations. The number of institutions setting up medical service fees,pharmacy service fees,and increasing the price of medical services increased significantly. After the implementation of the bonus policy,the average medical expenses for outpatients was 178.61 yuan,which was 2.32% higher than before the cancellation 174.56 yuan. The average medical expenses for inpatients was 6357.78 yuan,which was 4.99 percent higher than before the cancellation 6055.06 yuan. After the policy was abolished,the average drug cost for outpatients was 66.93 yuan,which was 1.15% higher than before the cancellation 66.17 yuan. The average drug cost for inpatients was 1742.27 yuan,which was0.31% lower than before the cancellation 1747.71 yuan. Medical income and government financial subsidies are far less than the reduction in drug revenues after the cancellation,with a gap of 66147.37 million after the total elimination of drug additions,the proportion of outpatient and inpatient drugs has declined. Conclusion: After the cancellation,the average medical and medical expenses of the outpatients increased slightly. There was a decline of the drug revenue ratio in the clinic and hospital income. The income and financial subsidies after the implementation of the policy were far less than the drug income after the drug was added.
引文
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[2]程繁银,于丽萍.健全医院绩效考评制度,促进医院健康发展[J].中国卫生事业管理,2009(3):165-166.
[3]周绿林,皱玲红.消药品加成后公立医院的补偿机制探讨[J],中国药房,2012,23(1):9-11.
[4]张静,韩菊,张晶. DRGs-PPS模式与项目付费模式的比较分析[J],中国卫生经济,2014,33(2):64-65.
[5]李敏.公立医院取消药品加成后如何调整补偿机制的探索[J].中国公共卫生事业管理,2015(2):118-120.
[6]吴有良,贺旭.试论与取消药品加成相关联的支出措施[J].中国药房,2014,25(45):4-243.
[7]谭华伟,阳光、颜维华.我国县级医院取消药品加成补偿政策的合理性研究[J].中国药房,2016,27(10):1301-1304
[8]田昕,宋雅然,张新平.以系统理论分析国家基本药物制度[J].中国卫生事业管理,2010(4):243-245.