上海市某区区属公立医院全面预算管理研究

目的]分析上海市某区区属公立医院实施全面预算管理对医院经济运行的影响,发现问题并提出政策建议。方法]采用定量分析与定性访谈相结合,分析区属公立医院实施全面预算管理后的医疗服务能力、医药费用增长、患者就医负担、收入结构调整、运行成本效率、预算执行情况,以反映医院的经济运行情况。结果]2013-2017年区属医院业务量指标均保持逐年上升的稳定态势,门急诊人次、出院人数、住院手术人次的年均增幅分别为5.69%、7.82%、11.54%,每职工平均门急诊人次、每职工出院人数年均增幅分别为15.38%、17.70%;医疗收入年均增幅为12.56%;2017年药品收入为36.41亿元,低于2016年的36.48亿元。门急诊均次费用、出院者平均医药费用年均增幅分别为4.34%、3.28%;出院者平均住院天数年均降幅为2.70%。药占比呈现逐年下降的趋势;卫生材料收入占比始终处于20%以下。医疗收入与成本比基本保持在1左右;在职职工人均工资性收入年均增幅为13.72%,高于医疗费用12.56%的增幅。主要预算指标执行率趋近100%。结论]实施全面预算管理使区属医院事业发展的计划性、协调性、科学性和可控性得到明显提升,但仍面临预算管理主体的职责范围尚未明晰、预算管理过程缺少动态管控和实时监测、预算考核机制有待进一步健全等问题。

Study on comprehensive budget management of public hospitals in a district of Shanghai

Objective To analyze the influence of implementing comprehensive budget management to economic operation of public hospitals in a district of Shanghai,identify problems and propose policy suggestions. Methods Quantitative analysis combined with qualitative interviews to analyze medical service capacity, increase of medical expenses, burden of patients ’ medical treatment, adjustment of income structure,operation cost efficiency and budget implementation after implementing comprehensive budget management,to reflect economic operation of hospitals. Results From 2013 to 2017,volume indicators of district hospitals maintained a steady trend of increasing year by year. Average annual growth rate of outpatient and emergency visits,number of inpatients and number of inpatient surgeries were 5. 69%,7. 82% and11. 54% respectively. Average annual growth rate of number of outpatient and emergency visits per employee and number of discharged patients per employee were 15. 38% and 17. 70% respectively. Average annual growth rate of medical income was 12. 56%. Drug income was 3. 641 billion yuan in 2017 which was lower than 3. 648 billion yuan in 2016. Average annual growth rate of average outpatient and emergency expenses and average medical expenses of discharged patients were 4. 34% and 3. 28% respectively. Annual average decline of average length of stay was2. 70%. Drug proportion decreased year by year. The proportion of healthcare material income was below 20% from beginning to end. The ratio of medical income to cost kept around 1. Average annual growth rate of wage income per employee was 13. 72%,higher than 12. 56% of medical expenses. The implementation rate of major budget indicators was approaching 100%. Conclusions The planning, coordination,scientificity and controllability of career development of district hospitals have been significantly improved after implementing comprehensive budget management. But it still faces problems such as unclear duty scope of the budget management subject,lack dynamic control and real-time monitoring in the process of budget management,and budget assessment mechanism needs to be perfected further.