江苏省综合医院“药占比”指标分析研究
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摘要
目的:为医疗费用控制措施调整提供可行性建议。方法:对2004-2016年江苏省综合医院门诊及住院患者药占比、次(人)均药品费用、次(人)均医药费用、次(人)均医疗费用增长率等指标进行统计,分析江苏省"药占比"指标控费的实施效果,剖析医药费用具体的增长方面。结果与结论:门诊、住院患者的"药占比"分别由2004年的55.40%、47.84%下降至2016年的43.18%、36.24%,次(人)均药品费用分别由2004年的75.89、2 852.60元上升至2016年的113.70、4 421.74元,次(人)均医药费用分别由2004年的136.98、5 960.71元上升至2016年的263.30、12 203.00元,次(人)均医疗费用增长率分别由2005年的1.62%、4.92%转变为2016年的6.17%、3.15%。江苏省综合医院医疗费用控制措施实施效果不理想,药品费用、医疗费用持续增长;检查费、医疗费、卫生材料费用占比较大,对医疗费用整体控制产生了消极结果。建议卫生行政部门和政策制订部门应建立规范的合理用药机制、结构合理化的考核指标体系和完善的公立医疗机构补偿机制,才能从根本上解决医疗费用快速增长的问题。
OBJECTIVE:To provide feasible suggestions for the adjustment of medical cost control measure. METHODS:The drug proportion of outpatients and inpatients,drug cost per time(capita),medical cost per time(capita) and increase rate of medical cost per time(capita) were analyzed in general hospitals of Jiangsu province during 2004-2016. The effects of drug proportion index cost control were analyzed in Jiangsu province,and special increase fields of medical cost was also analyzed.RESULTS & CONCLUSIONS:The drug proportion of outpatients and inpatients decreased from 55.40%,47.84% in 2004 to43.18%,36.24% in 2016;drug cost per time(capita)increased from 75.89,2 852.60 yuan in 2004 to 113.70,4 421.74 yuan in2016;medical cost per time(capita)increased from 136.98,5 960.71 yuan in 2004 to 263.30,12 203.00 yuan in 2016;increase rate of medical cost per time(capita)changed from 1.62%,4.92% in 2005 to 6.17%,3.15% in 2016. The effects of medical cost control measure were not satisfactory in general hospitals of Jiangsu province, and drug cost and medical cost increased continuously. The examination cost,medical cost and medical material cost accounted for a large proportion,which had a negative effect on the overall control effect of medical cost. The health administrative departments and policy-making departments should establish standard rational drug use mechanism and evaluation index system of structure rationalization,improve compensation mechanism of public medical institutions to solve the problem of rapid growth of medical cost.
OBJECTIVE:To provide feasible suggestions for the adjustment of medical cost control measure. METHODS:The drug proportion of outpatients and inpatients,drug cost per time(capita),medical cost per time(capita) and increase rate of medical cost per time(capita) were analyzed in general hospitals of Jiangsu province during 2004-2016. The effects of drug proportion index cost control were analyzed in Jiangsu province,and special increase fields of medical cost was also analyzed.RESULTS & CONCLUSIONS:The drug proportion of outpatients and inpatients decreased from 55.40%,47.84% in 2004 to43.18%,36.24% in 2016;drug cost per time(capita)increased from 75.89,2 852.60 yuan in 2004 to 113.70,4 421.74 yuan in2016;medical cost per time(capita)increased from 136.98,5 960.71 yuan in 2004 to 263.30,12 203.00 yuan in 2016;increase rate of medical cost per time(capita)changed from 1.62%,4.92% in 2005 to 6.17%,3.15% in 2016. The effects of medical cost control measure were not satisfactory in general hospitals of Jiangsu province, and drug cost and medical cost increased continuously. The examination cost,medical cost and medical material cost accounted for a large proportion,which had a negative effect on the overall control effect of medical cost. The health administrative departments and policy-making departments should establish standard rational drug use mechanism and evaluation index system of structure rationalization,improve compensation mechanism of public medical institutions to solve the problem of rapid growth of medical cost.
引文
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[3]谭礼萍.住院医疗费用构成的结构变动度分析[J].中国卫生统计,2015,32(3):441-442、445.
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[18]夏应勇,王立云.医院药占比相关影响因素研究[J].中国药业,2017,26(10):77-79.
[19]钱小蔷,徐永中.新医改形势下合理控制医院药占比的效果分析[J].江苏卫生事业管理,2017,28(6):13-15.
[20]黄佳盛,陈伟岚.浅论控制“药占比”存在的问题与措施[J].临床医药文献电子杂志,2016,3(25):5119-5120.
[21]杨冬.药物经济学及其在药品费用控制中的作用[J].临床医药文献电子杂志,2017,4(23):4520-4522.
[22]刘万韬.我国药品价格形成机制及市场化改革路径研究[J].价格月刊,2017(1):45-50.
[23]中国报告网.2018年中国医药行业分析报告[EB/OL].[2017-10-04].http://baogao.chinabaogao.com/zhongxiyao/332872332872.html.
[2]陈沛军,黎东生,黄鹤冲.基于GM(1,1)模型的我国综合医院人均医药费用预测分析[J].中国卫生事业管理,2015,32(12):899-901.
[3]谭礼萍.住院医疗费用构成的结构变动度分析[J].中国卫生统计,2015,32(3):441-442、445.
[4]徐长生,张泽栋.城镇化、老龄化及经济发展对我国医疗费用影响回归分析[J].中国卫生经济,2015,34(6):54-55.
[5]张薇.基于DRGs对医疗机构住院患者可比药占比的研究[D].大连:大连医科大学,2014.
[6]陆瑜,司梁宏,刘子修,等.药占指数的概念及其应用研究[J].中国药房,2014,25(13):1242-1244.
[7]温小霓,刘鹏,杨楠堃.人口老龄化与经济增长下的医疗费用预测[J].中国卫生经济,2014,33(2):56-59.
[8]迟蔚蔚,高海燕,王清亮,等.病例分型与医疗费用支付方式的相关性研究[J].中国医院管理,2013,33(10):51-53.
[9]罗旋.综合医院体检机构建筑设计研究[D].重庆:重庆大学,2013.
[10]丁建强,吴爱京,朱军,等.我院2006-2011年药品应用情况分析[J].中国药房,2012,23(26):2416-2419.
[11]王阿娜.医疗费用的控制与医疗保险支付方式的改革[J].宏观经济研究,2012(5):76-79.
[12]丁晓英.2011年1-6月某统筹区26家医院住院患者基本医疗保险药品应用情况分析[J].中国药房,2012,23(4):361-363.
[13]方青.经济杠杆在控制医药费用中的应用[J].卫生经济研究,2011(8):34-35.
[14]国家卫生和计划生育委员会.医院管理评价指南(试行)[S].2008-05-13.
[15]郜佳,陈丹镝,崔欢欢,等.城市公立医院药品零差率及补偿机制的实证研究[J].中国药房,2017,28(31):4341-4345.
[16]董浩然,游雅慧.浅谈“零差率”后的“二次议价”现状及其解决途径[J].现代农村科技,2016(8):10-11.
[17]于保荣,田畅,柳雯馨.公立医院补偿机制改革问题及建议[J].卫生经济研究,2017(2):9-13.
[18]夏应勇,王立云.医院药占比相关影响因素研究[J].中国药业,2017,26(10):77-79.
[19]钱小蔷,徐永中.新医改形势下合理控制医院药占比的效果分析[J].江苏卫生事业管理,2017,28(6):13-15.
[20]黄佳盛,陈伟岚.浅论控制“药占比”存在的问题与措施[J].临床医药文献电子杂志,2016,3(25):5119-5120.
[21]杨冬.药物经济学及其在药品费用控制中的作用[J].临床医药文献电子杂志,2017,4(23):4520-4522.
[22]刘万韬.我国药品价格形成机制及市场化改革路径研究[J].价格月刊,2017(1):45-50.
[23]中国报告网.2018年中国医药行业分析报告[EB/OL].[2017-10-04].http://baogao.chinabaogao.com/zhongxiyao/332872332872.html.