北京市医药分开综合改革对门急诊费用控制的机制研究

Abstract

目的:评价北京市医药分开综合改革对医疗机构门急诊总费用的机制及影响.方法:对北京市89家三级公立医院、78家二级公立医院和206家一级医院与社区卫生服务机构的监测数据和历史数据进行分析,比较2017年一二季度与2016年一二季度门急诊费用的变化,并分析服务利用和服务价格因素对门急诊费用变化的影响机制.结果:2017年二季度监测医疗机构的门急诊总费用为173.77亿元,扣除物价因素后,较2016年同期减少1.14%,费用增速下降2.46%.三级医院和二级医院费用较历史同期水平分别减少了2.82%和3.02%,增速分别下降4.06%和3.74%.基层医疗卫生机构费用较历史同期水平增加17.09%,2017年二季度增速为26.28%,比2016年(15.84%)大幅度提升.医疗机构服务价格和服务利用对门急诊费用变化的贡献分别为6.98%和-7.65%.三级医院价格和利用对门急诊费用控制的贡献分别为10.37%和-12.00%.二级医院价格和利用的贡献分别为0.72%和-3.35%.基层医疗卫生机构的价格和利用对门急诊费用控制的贡献分别为6.08%和9.57%.结论:北京市医药分开综合改革通过调整卫生服务利用,有效控制了门急诊费用的过快增长.

Objective:To evaluate the impact and analyze the mechanism of separating drug sales from medical services reform on the total medical expenditure containment of outpatient services in Beijing. Methods:The monitoring data and historical data from 89 third-level,78 second-level public hospitals,and 206 primary health institutions and community health service agencies,which participated in the reform,were analysed to estimate the impacts on outpa-tient service utilization and service price. The analysis was based on the data of the first and second quarters of 2016 outpatient and emergency department fee changes,and analysis of service utilization and service price factors on the im-pact of changes in outpatient and emergency services mechanism. Results:The total outpatients'expenditure in Beijing in the second quarter of 2017 was 17.38 billion yuan,representing a slight decrease of 1.14% than the expenditure in 2016. The growth rate reduced by 2.46%. Expenditure in third-level and second-level hospitals decreased by 2.82% and 3.02%,respectively,with reductions in growth rates of 4.06% and 3.74% respectively. Expenditure in primary institutions increased by 17.09%. The increase rate in the second quarter of 2017 was 26.28%,representing a remark-able increase compared to the rate in 2016(15.84%). The contribution from the medical institution service prices and service utilization to the change of outpatient and emergency medical expenditure containment was 6.98% and -7. 65%,respectively. For third-level hospitals,the contribution was 10.37% and -12.00%,respectively;second-level hospitals were 0.72% and -3.35%,respectively;and the primary health institutions was 6.08% and 9.57%. Con-clusions:Beijing's comprehensive reform of separating drug sales from medical services reform has effectively controlled the rising medical expenditure of outpatient services,mainly by adjusting outpatients service utilization between differ-ent level healthcare institutions.