城市公立医院药品零差率及补偿机制的实证研究
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篇名: 城市公立医院药品零差率及补偿机制的实证研究
TITLE:
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 reference for developing zero-profit drug policy and compensation mechanism better in urban public hospitals. METHODS: Taking a public hospital in a city as an example, effects of zero-profit drug policy on hospitals, patients, health insurance fund and single diseases with different drug proportions [cataract (2.94%) vs. chronic renal failure (38.77%)] were investigated by analyzing the canceled drug addition costs and adjusted medical service price data after developing zero-profit drug policy. RESULTS: After developing zero-profit drug policy, the overall compensation rate in the public hospital was 95.20%. The overall burden of urban patients was reduced, average burden cost was decreased 197.73 yuan every time; while the overall burden of urban and rural residents had increased, average burden cost was increased 17.39 yuan every time; and the overall burden of all patients had decreased. Health insurance fund had decreased, in which, the urban workers were decreased   151 185 500 yuan, and urban and rural residents were increased 4 550 400 yuan. In medical insurance for urban workers and health insurance for urban and rural residents, hospital increased by 7.00% and 8.99% in income in the treatment of cataract, the medical insurance fund increased by 12.07% and 13.67%, and patients’ burden increased by 0.58% and 3.43%, respectively. For chronic renal failure, hospital income increased by 3.23% and 3.93%, medical insurance fund decreased by 3.19% and 3.96%, and patients’ burden decreased by 4.27% and 3.63%, respectively. CONCLUSIONS: Zero-profit drug policy is the ideal measure for getting rid of “drug-maintaining-medicine”. When developing the policy, it should be combined with actual situation and different diseases to explore adjustment of medical service prices, reasonable financial compensation models and medical insurance payment mechanism.
期刊: 2017年第28卷第31期
作者: 郜佳,陈丹镝,崔欢欢,江莉,周亚旭
AUTHORS: GAO Jia,CHEN Dandi,CUI Huanhuan,JIANG Li,ZHOU Yaxu
关键字: 城市公立医院;药品零差率政策;补偿机制;患者;医保基金
KEYWORDS: Urban public hospitals; Zero-profit drug policy; Compensation mechanism; Patient; Health insurance fund
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