北京市胆囊结石患者住院费用变化研究*

目的：研究北京市胆囊结石患者住院费用在医药分开综合改革与医耗联动综合改革 (以下统称两轮综合改革) 前后的变化情况，总结两轮综合改革的成果与不足。方法：应用间断时间序列分析对北京市111家二三级医院两轮综合改革前后胆囊结石患者例均住院总费用及明细费用的变化情况进行分析。结果：北京市两轮综合改革后，二三级医院胆囊结石患者例均住院总费用略有增加，例均药品和材料费用占比减少，例均医疗费用占比增加。二级医院例均医疗费用和例均材料费用在两轮综合改革后呈增长趋势，三级医院例均药品费用在两轮综合改革后呈下降趋势，例均医疗费用则继续增长。结论：两轮综合改革基本实现预期政策目标，建议加强医用耗材治理，优化医院内外部补偿机制和推进分级诊疗制度建设，提升公立医院改革效果。

Research on the Change of Hospitalization Expenses of Patients with Gallstones in Beijing

Objective: To study the changes of hospitalization expenses of gallstone patients before and after the comprehensive reform of separation of medicines and medical consumption in Beijing, and evaluate the achievements and existing problems in these two rounds of reforms. Methods: The interrupted time series (ITS) model was applied to analyze the changes of total and detailed hospitalization expenses before and after the two reforms in 111 secondary and tertiary medical institutions in Beijing. Results: After the reforms, the total hospitalization expenses of patients with gallstones in secondary and tertiary medical institutions increased slightly, and the drug and material expense per capita percentages declined, while the medical expense rose. The average medical expenses and material expenses per capita of secondary medical institutions increased after reforms, the average drug expenses of tertiary medical institutions decreased after reforms, while the medical expenses per capita continued to increase. Conclusion: These two rounds of reform have basically achieved the expected policy goals. It is suggested to strengthen the management of medical consumables, optimize the internal and external compensation mechanism of hospitals, promote the construction of the hierarchical medical system, and improve the effectiveness of public hospital reform.