城市公立医院药品零差率及补偿机制的实证研究

发布时间：2018-03-04 20:32

本文选题：城市公立医院　切入点：药品零差率政策　出处：《中国药房》2017年31期 　论文类型：期刊论文

【摘要】：目的:为城市公立医院药品零差率政策及补偿机制的更好实施提供参考。方法:以某市城市公立医院为例,通过对药品零差率政策实施下取消的药品加成费用、调整的医疗服务价格数据进行分析,考察药品零差率政策对医院、患者、医保基金以及实施前药占比不同的单病种[白内障(药占比2.94%)vs.慢性肾功能衰竭(药占比38.77%)]的影响。结果:实行药品零差率政策后,该市公立医院的整体补偿率为95.20%;城镇职工医保患者整体负担降低,次均负担费用降低了197.73元/次,城乡居民医保患者整体负担略有增加,次均负担费用增加了17.39元/次,但全部患者的整体负担有所降低。医保基金负担整体降低,其中城镇职工医保基金降低了15 118.55万元,城乡居民医保基金负担降低了455.04万元。在城镇职工医保和城乡居民医保两种医保方式下进行白内障治疗,医院收入分别增加了7.00%、8.99%,医保基金负担分别增加了12.07%、13.67%,患者负担分别增加了0.58%、3.43%;在两种医保方式下进行慢性肾功能衰竭治疗,医院收入分别降低了3.23%、3.93%,医保基金负担分别降低了3.19%、3.96%,患者负担分别降低了4.27%、3.63%。结论:药品零差率政策是我国目前破除"以药养医"机制较理想的措施,但在实施过程中需结合医院实际情况和不同病种,探讨医疗服务价格的调整方式、财政合理的补偿措施和医保付费机制。
[Abstract]:Objective: to provide a reference for the better implementation of the policy of zero difference rate of drugs and the mechanism of compensation in public hospitals. Methods: taking a city public hospital as an example, the cost of drug addition cancelled under the implementation of the policy of zero difference rate of drugs was analyzed. The adjusted price data of medical services were analyzed to investigate the policy of zero difference rate of drugs for hospitals, patients, Effects of Medicare funds and pre-medication ratios on single diseases [cataract (2.94%). Chronic renal failure (38.77%)]. Results: after the implementation of the zero-difference rate policy, The overall compensation rate of the public hospitals in the city is 95.20%, the overall burden of urban workers and employees on medical insurance is reduced by 197.73 yuan per time, and the overall burden of medical insurance patients in urban and rural areas has slightly increased, and the average cost of the secondary medical insurance has increased by 17.39 yuan per time. But the overall burden of all patients has been reduced. The overall burden of the medical insurance fund has been reduced as a whole. Among them, the medical insurance fund for urban workers has been reduced by one hundred and fifty-one million one hundred and eighty-five thousand and five hundred yuan. The burden of medical insurance fund for urban and rural residents was reduced by four million five hundred and fifty thousand and four hundred yuan. Cataract treatment was carried out under the two forms of medical insurance for urban workers and urban and rural residents. The hospital income increased by 7.00 and 8.99, the burden of the medical insurance fund increased by 12.07 and 13.67, and the patient burden increased by 0.58 and 3.43 respectively. Under the two forms of medical insurance, chronic renal failure was treated. The hospital income was reduced by 3.233.93, the burden of medical insurance fund was reduced by 3.19 and 3.96, and the burden of patients was reduced by 4.27 and 3.63.Conclusion: the policy of zero difference rate of medicine is an ideal measure to break down the mechanism of "nourishing medicine with drugs" in our country at present. But in the process of implementation, we should combine the actual situation of hospital and different kinds of diseases, discuss the adjustment of medical service price, the reasonable compensation measures of finance and the mechanism of medical insurance payment.
【作者单位】：四川大学华西公共卫生学院;华中科技大学同济医学院医药卫生管理学院;
【基金】：成都市发展与改革委员会资助课题(No.H161113)
【分类号】：R951

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