上海市实施医疗机构药品零差率与相关补偿政策研究

目标:实证研究药品加价率下降后,医院经济运行及医药费用的变化,并提出实行药品零差率相关补偿政策。资料与方法:对上海市医疗机构2003—2008年财务报表数据(含复旦附属医疗机构)进行定量分析。结果:实证研究表明,2006年实施控制药品加价率政策后,上海市医疗机构的药品加价率从33%下降至17%;药品收入仍然是医疗机构主要的收入来源;随着药品收支结余的减少,有37%的医疗机构出现了亏损;医药费用并没有因药品加价率的降低而减少;若实行药品零差率政策,上海市医疗机构每年所需补偿约30亿元;经测算,不同补偿渠道的补偿结果将会对患者医药费用产生不同影响。建议:实行药品零差率后应采用综合补偿模式,通过政府财政出一点、医疗保险分担一点、药事服务收费补一点和医疗服务价格调一点,建立医疗机构主动合理控制药品费用的长效机制,既维护医院的正常运行,又减轻患者就医的经济负担。

The study on zero profit drug supply and the corresponding reimbursement policy in medical institutions in Shanghai

Objectives：This article is to analyze the change of economic status of hospitals and health expenditure after executing the policy controlling drug mark-up rate,and to put forward the corresponding reimbursement on implementing zero profit drug supply policy as well. Data and methods：Quantitative analyze from annual financial reports from 2003 to 2008 of local hospitals in Shanghai （including the hospitals affiliated of Fudan University）. Results：The drug mark-up rate had decreased from 33% to 17% after the policy for controlling drug mark-up rate had been implemented; Medicine revenues had still been the main revenue of hospitals; there had been taken a loss in 37% of hospitals since medicine revenues were reduced; health expenditure had not been saved with the decrease of drug mark-up rate; the total compensation would be 3 billion per year if implementing zero profit drug supply policy; different source of compensation would cause different results of health expenditure. Recommendations：Integrated compensation program should be applied after implementing zero profit drug supply policy,including government input improved,health insurance shared,pharmacy service fee set up and medical service price increased,in order that the long mechanism of controlling health expenditure from hospitals will be established which can not only maintain economic status of hospitals but also lighten the economic burden from patients.