药品零差价政策对四川省县级公立医院住院次均费用的影响——基于灰色关联和结构变动分析

发布时间：2018-01-14 08:26

本文关键词：药品零差价政策对四川省县级公立医院住院次均费用的影响——基于灰色关联和结构变动分析　出处：《现代预防医学》2017年09期 　论文类型：期刊论文

【摘要】：目的探讨药品零差价政策实施后对四川省县级公立医院患者住院次均费用的影响,观察各影响因素的变动情况,提出应对相关变化的政策建议。方法对2010-2015年四川省县级公立医院住院次均住院费用数据进行灰色关联法和结构变动度分析,定量评价各年份住院费用各因素之间的关联程度和结构变动。结果在6年间次均住院费用增长31.68%,药品零差价政策实施后,药费的关联度最大(1.000 0),其次是以卫生材料费和化验费为主要构成的其他费用(0.888 8);结构变动贡献率中,其他费用(卫生材料费和化验费等)的结构变动贡献率最大(37.05%),其次是药费(23.91%),两者的累计贡献率为60.96%,是主要影响次均住院费用的因素。结论药品零差价政策,初见成效,药品费用占住院次均费用比例出现下降趋势,以卫生材料和化验费为主的其他费用增长明显,关联性强,结构变动贡献率大,整体变动结构不太合理,建议进一步完善药品零差价政策实施,控制其他费用增长,建立县级公立医院合理的激励和监管机制。
[Abstract]:Objective to investigate the effect of the zero difference policy on the average hospitalization cost of patients in county public hospitals in Sichuan province and to observe the change of influencing factors. Methods the average hospitalization cost data of county public hospitals in Sichuan province from 2010 to 2015 were analyzed by grey correlation method and structural change degree. The results showed that the average hospitalization cost increased 31.68 times in 6 years, and after the implementation of the zero difference policy of drugs, the correlation degree and structure change among the factors of hospitalization expenses in each year were quantitatively evaluated. The correlation degree of drug cost is the highest (1.000 0%), followed by other expenses (0.888 8%), which are mainly composed of health materials cost and test fee. In the contribution rate of structural change, the contribution rate of other expenses (health materials cost and laboratory fee etc.) was the biggest (37.05%), followed by drug fee (23.91%). The accumulative contribution rate of both is 60.96, which is the main factor that affects the average hospitalization cost. Conclusion the policy of zero difference of drug price is effective, and the proportion of drug cost to the average cost of hospitalization is decreasing. Other expenses, which are mainly sanitary materials and laboratory fees, have obvious growth, strong correlation, large contribution rate of structural changes, and unreasonable overall structure. Therefore, it is suggested to further improve the implementation of the zero difference policy of drugs. To control the growth of other expenses and establish a reasonable incentive and supervision mechanism for county-level public hospitals.
【作者单位】：四川大学华西公共卫生学院(华西第四医院);浙江省医院发展中心改革研究部;
【分类号】：R95
【正文快照】： 四川省自出台《关于县级公立医院综合改革试点工作的实施意见》(川办发[2013]4号),宣布在全省27家试点县级公立医院实施药品零差率,降低大型医用设备检查、治疗费用[1]。在县级公立医院实施了以药品零差率为切入口的综合改革,取消了“以药补医”机制,调整了医疗服务价格,建立

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