南京市属公立医院医药价格综合改革补偿效果评价

目的:分析南京市城市公立医院医药价格综合改革后各医院药品收支、医疗服务收入变化,评价补偿效果,探索差异化补偿方案,为建立动态调整的补偿机制提供依据。方法:选择市属参改医院共10家,收集改革前48个月(2011.11—2015.10)及改革后12个月(2015.11—2016.10)财务收支数据,采用简单线性间断时间序列模型对药品收支差率、取消药品加成损失、医疗服务收入增长率、财政补偿率、医疗服务收入补偿率、综合补偿率进行分析。结果:改革后平均药品收支差率净下降14.24个百分点,医疗服务收入净增长24.29%;药占比平均从42.7%下降到36.9%,医疗服务占比从26.1%上升到30.3%。补偿上,净财政补偿率平均为20.43%、净服务补偿率平均为87.34%,达到政策目标,但净服务补偿率从-21.92%到712.52%不等、净综合补偿率从28.87%到712.52%不等,差异较大。其中,服务补偿率与改革前医疗服务收入占比显著正相关。结论:南京价改在取消药品加成和"80%服务+20%财政"补偿效果上政策目标基本实现,但各医院之间差异较大,服务依赖型医院补偿率超过400%,药品依赖型不到30%,而综合性医院因医疗收入结构和经营效率不同,从50%到100%不等。建议:进一步落实调价范围和调价力度,按年建立动态且差异化的补偿机制。

Effect evaluation of comprehensive reform of medical price in urban public hospital: A case study of Nanjing city

Objectives:This study aims to analyze the change of income and medical service revenue of hospitals in Nanjing after the comprehensive reform of the medical prices of public hospitals, evaluate the effect of compensation and explore the differentiated compensation plan, and provide the basis for establishing the compensation mechanism of dynamic adjustment. Methods:A total of 10 municipal-affiliated hospitals were selected to collect financial income and expenditure data for the 48 months before the reform (2011.11-2015.10) and the 12 months after the reform (2015.11-2016.10) in Nanjing, and used interrupted time series model to estimate the growth rate of drug profit and service revenue, and finally made a comparison between the counterfactual and actual figures. Results:It was found that, after the form, the drug profit decreased by 14.98%, and the service revenue increased by 24.79%. The revenue from medicines accounted for 42.7% and 36.9% before and after the reform respectively, and service for 28.9% and 30.3% respectively. The net financial aid accounted for 20.43% of the total drug-sales loss in average, and the net service revenue rate averaged 87.3% meeting the policy target, but within the 10 hospitals these rate ranged diversely from -21.9% to 712.5%, and 28.9% to 712.5%. The regression analysis indicated that the service compensation rate was significantly positively correlated with the proportion of service revenue in the total medical revenue before the reform. Conclusions:The Nanjing Pricing Reform basically achieved its desired goals of abolishing the drug-sales addition and the hospital compensation effect of 80% service +20% fiscal structure from service revenue and financial aid in average. However, the compensation differences among the hospitals are quite large with service-dependent hospitals compensated by over 400% and drug-dependent hospital less than 30%. However, for general hospitals, the compensation rated directly depended on the revenue structure before the reform and management performance and varied from 50% to 100%. The study at last gave its advices on improvement to further increase the service prices and establish a yearly-adjusted individualized compensation mechanism.