摘要
目的:通过评价东部某省5个县的8家县级公立医院医药价格改革实施情况,了解其改革进展及效果,总结经验与问题,并提出相应建议。方法:采取自身前后比较评价设计分析医药价格改革前后的变化,通过时间间断序列分析法判断此次改革对医务人员医疗行为以及脑出血、剖宫产及胆囊切除术住院患者的医疗费用产生的影响,并采取关键知情人访谈和半结构焦点组访谈方式,分析医务人员和患者对医药价格改革的参与程度及态度。结果:8家公立医院医药价格改革初步取得了较好进展。机构运行平稳,收支结余扩大的同时其结构得以优化,药品占比不断降低,人员投入增加;机构内部管理机制不断精细化,人员行为得到规范,次均医疗费用增加不显著,服务效率提升较快。然而,各县财政补偿情况差异较大,支付方式改革尚未完全与医药价格改革政策相配套,导致机构仍然以单纯增加工作量来弥补药品收入的损失,医务人员收入虽略有增加,仍不足以体现其劳动付出价值,医务人员抱怨颇多。虽然医保支出增加,保障水平持续提高,但患者实际就医负担仍呈缓慢提高态势。结论:该省医药价格改革虽然初步取得一些效果,但长效的"以药补医"退出机制尚未建立,需要辅以稳定的财政补偿机制和精细化医保管理政策。
Objective： To learn the impact of medical pricing reform in 5 counties of an eastern province in Chi- na, and to generate experiences and identify lessons for an upgrade of similar mechanisms in other parts of the coun- try. Methods： Pre-post evaluation design was adopted to study changes brought by the medical pricing reform and its associated reform initiatives, and quantitative methods like interrupted time series （ITS） analysis were employed to analyze provider behavior changes and cost changes of three kinds of patients （ C-section, cerebral hemorrhage and gallbladder removal） , while qualitative methods including key informant interviews and focal group discussions were used to learn of attitude and perception changes of local reform implementers, health providers and patients. Results ： Medical pricing reform basically achieved its target by substituting over 80% of drug income losses. County hospitals had smooth operations while seeing an optimal adjustment of income and spending structures, typically with lower drug shares and increasing personnel expenditures. Moreover, provider behaviors were controlled, service efficiency was improved and per capita out- and inpatient costs remained constant. However, adjustment of public financing and health insurance policies was not fully compatible to changes in pricing policy. Providers were discontented with cur- rent reform due to increased workloads and slow increases in salary. Health insurance schemes saw rapid increases in fund usage, which may threaten the safe usage of insurance funds. Conclusions ： Medical pricing reform achieved pre- liminary expected outcomes. However, abnormal hospital financing mechanisms （compensating medical revenue with drug income） still existed and further reforms were called for.
出处
《中国卫生政策研究》
CSCD
北大核心
2015年第1期14-20,共7页
Chinese Journal of Health Policy
基金
世界银行项目
关键词
县级公立医院
医药价格改革
以药补医
County public hospitals
Medical pricing reform
Compensating medical revenue with drug income
