上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（公共卫生） • 上一篇    下一篇

药品零加成对医疗费用的影响及补偿机制探索

潘悦华，崔梦迪，李雪辉   

  1. 上海交通大学 医学院附属瑞金医院北院财务绩效部， 上海 201801
  • 出版日期:2015-11-28 发布日期:2016-01-13
  • 通讯作者: 李雪辉, 电子信箱: xuehuili@126.com。
  • 作者简介:潘悦华（1976—）， 女， 中级会计师， 本科; 电子信箱: pyh30283@rjh.com.cn。
  • 基金资助:

    上海申康医院发展中心项目 (2014SKMR-30, SHDC2014621)

Study on effect of zero-profit medicine policy on medical expenses and compensation mechanisms

PAN Yue-hua, CUI Meng-di, LI Xue-hui   

  1. Department of Financial Performance, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China
  • Online:2015-11-28 Published:2016-01-13
  • Supported by:

    Project of Shanghai Hospital Development Center, 2014SKMR-30, SHDC2014621

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摘要：

目的  跟踪调查上海交通大学医学院附属瑞金医院北院实施药品零加成之后费用差异，编制门急诊、住院费用调价前后主成分分析表，分析各因素对医药费用的影响程度并提出补偿机制建议。方法  运用配对样本t检验分析对门急诊费用和住院费用进行调价前后的差异性测评；采用主成分分析法分析影响门急诊费用及住院费用调价前后的影响因素及其程度。结果  门急诊、住院费用在调价前后差异明显，且各影响因素重要性程度有明显变化，但取消药品加成会导致医院总体收入和结余出现一定幅度减少，医院收支出现不平衡。结论  取消药品加成可以促进医疗费用结构合理化，进一步体现医务人员劳务价值，并对缓解医患矛盾有积极意义，然而还需制定一系列科学补偿措施,例如药事服务费、合理调整收费结构等来弥补医院收支不平衡的问题，保障公立医院有序健康发展。

关键词: 公立医院, 药品零加成, 药事服务费, 补偿机制

Abstract:

Objective  To track and investigate the difference in cost after zero-profit medicine policy was implemented in Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, prepare the principal component analysis table of outpatient expenses, emergency expenses, and hospitalization expenses before and after adjustment of prices, analyze the impact of each factor on medical expenses, and propose compensation mechanism. Methods  The difference evaluation of outpatient expenses, emergency expenses, and hospitalization expenses before and after adjustment of prices was analyzed by the paired samples t test. The influencing factors of outpatient expenses, emergency expenses, and hospitalization expenses before and after adjustment of prices and the degree of their impact were analyzed by the principal component analysis. Results  Outpatient expenses, emergency expenses, and hospitalization expenses were remarkably different before and after adjustment of prices and the importance of each factor changed significantly. The zero-profit medicine policy caused a substantial reduction in hospital’s overall income and surplus and payment imbalance. Conclusion  The zero-profit medicine policy can rationalize the structure of medical expenses, reflect the labor value of medical staff, and effectively ease the contradiction between doctors and patients. However, it is still necessary to develop a series of scientific compensation mechanisms, such as pharmaceutical service fee and reasonably adjusting the charging structure, so as to compensate the payment imbalance and ensure the orderly and healthy development of public hospitals.

Key words: public hospital, zero-profit medicine policy, pharmaceutical service fee, compensation mechanism