广东省取消药品、耗材加成政策效果研究系列之二:医疗服务行为影响研究

[目的]取消药品、耗材加成政策背景下分析医疗服务价格政策调整的医疗服务行为情况,探讨医疗服务行为变化的影响因素。[方法]收集广东省516家公立医院2018年1-6月、2019年1-6月医院财务数据,运用t检验、相关分析等方法,进行医疗服务行为变化实证研究。[结果]2019年1-6月与2018年同期相比,医院收支较为平衡,略有结余。公立医院亏损面不断缩小;总诊疗人次、门急诊人次数、出院人次、手术量、平均住院日等服务量提高,指标变化差异均有统计学意义(P<0.05);药品支出与总收入相关系数降低;服务量增加和次均费用上涨是医疗收入增加的主要因素。[结论]改革政策目标基本实现,收入结构优化;服务量和服务效率提升。但仍存在不合理的医疗服务行为,存在转移成本、过度提供医疗服务量的倾向,有待建立和完善医疗行为的激励约束机制。

Series two-Study on the impact of medical service behavior after canceling drugs and consumables price addition in Guangdong Province

Objective To analyze medical services behavior under the background of canceling drugs and consumables price addition policy,and explore the influencing factors of medical service behavior changes.Methods The financial data of 516 public hospitals in Guangdong Province from Jan.to Jun.of 2018 and 2019 were collected,and empirical research on medical service behavior changes was used by T-test and correlation analysis method.Results Compared the two periods,the income and expenditure was relatively balanced,with a slight balance.The scale of losses of public hospitals had been shrunk.The number of person-time of general diagnosis and treatment,outpatients and emergency department visits,discharge,operation volume,and average length of hospitalization increased.There was statistically significant in difference of index changes(P<0.05).The correlation coefficient between drug expenditures and total income reduced.It found that the increase of service volume and average per cost were main factors for the increasing of medical income.Conclusions The goal of reform policies have been basically achieved,the income structure has been optimized,and the medical service volume and service efficiency have improved.However,there are still existing unreasonable medical service behaviors,and there is tendency of transferring costs and excessively providing medical services.It needs to establish incentive and constraint mechanism of perfecting medical behavior.