摘要
目的:评价北京市2012年实施的医药分开政策对五家试点医院医生诊疗行为以及医疗费用的影响。方法:以缺血性心脏病为例,采用有对照的前后比较设计来研究住院服务利用的变化。以五家试点医院为干预组,以非试点的所有三甲公立医院为对照组。2011年1月1日—2012年7月1日为干预前,2012年7月2日—2014年12月31日为干预后。数据来源于2011—2014年北京医保抽样数据库,采用倍差法及知情人深入访谈进行分析。与试点医院及非试点医院的医保办主任进行深入访谈,探索医药分开政策对评价指标的作用机制。结果:缺血性心脏病住院次均中药费用、次均实验室检查费用显著下降,次均综合服务费用显著增加;次均西药费用有所下降,但是没有统计学意义;中药费用的比例下降3.73%;综合服务费用比例增加2.58%;实验室检查费用比例和临床诊疗费用比例变化没有统计学意义。结论:医药分开相关政策改变了医院的费用结构,减少的药品费用平移到诊疗费用等其他费用,实现了收入的平移;在现有医保支付方式和医院收入分配制度下,医药分开政策对住院总费用和患者自付费用的影响不大;加强医院内部管理,严格管控绩效指标,对于规范医生行为具有一定作用。
Objectives：The study aims at assessing the impacts of separating drug sales from medical service pilots on prescription behavior and medical expense in pilot tertiary hospitals of Beijing. Methods：Taking the ischemic heart disease as example, a comparative study considering pre-and post-controls was designed to explore the changes in the use of hospital services by inpatients. The intervention group consisted of five pilot hospitals; and the control group was constituted by other non-pilot tertiary hospitals. For both groups, the pre-intervention occurred during the period from January 1st, 2011 to July 1st, 2012 while the intervention took place from July 2nd, 2012 to December 31st, 2014.Data were collected from Beijing Medical Insurance Sampling Database during the period from 2011 to 2014. The difference-in-differences model was employed during analysis and in-depth interviews with the directors of two different hospitals of different rankings （Pilot and non-pilot） to explore possible potential impact of the policy of separating drug sales from medical service pilots on the evaluation indicators including possible incentives to both hospitals and physicians. Results：In terms of hospitalization expenses for inpatients with ischemic heart disease and compared with non-pilot hospitals, the reform considerably decreased the expenses for traditional Chinese medicine. Meanwhile, the expenses of laboratory tests also declined, and the cost of comprehensive services significantly increased, while there was no significant change in the expenses of western medicine. The proportion of Traditional Chinese Medicine cost decreased by 3.73%; while comprehensive service cost proportion increased by 2.58%. There was no significant change in the proportion of laboratory and clinical treatment expenses. Conclusions：The policy of separating drug sales from medical service pilots has changed the income structures of pilot hospitals, decreased the drug expenses and increased the diagnosis and treatment expenses, and proved little the impact of the policy on the total hospitalization costs and inpatient＇s out-of-pocket payments. Based on the existing health insurance payment and hospital income distribution systems, the policy couldn＇t change the doctors＇ wrong incentives to provide excessive services. Therefore, strengthening the internal management of hospitals and strictly controlling performance indicators have a certain role in regulating the behavior of doctors.
作者
王俊锋
陈正超
崔斌
何映东
杨朔
沈玉卿
杨莉
WANG Jun-feng;CHEN Zheng-chao;CUI Bin;HE Ying-dong;YANG Shuo;SHEN Yu-qing;YANG Li(School of Public Health,Peking University,Beijing 100191,China)
出处
《中国卫生政策研究》
CSCD
北大核心
2018年第7期42-48,共7页
Chinese Journal of Health Policy
基金
国家自然科学基金面上项目(71273016
71673004)
关键词
医药分开政策
药品费用
诊疗费用
双重差分法
Separating drug sales from medical services
Drug expenses
Treatment expenses
Difference-in-differences
