基于结构变动度的药品零差价门诊医疗费用变化实证研究

目的]分析2009-2016年宁夏12家县级综合性公立医院实施药品零差价政策门诊费用的结构变化情况,为完善药品零差价政策提供参考。方法]收集12家县级医院2009-2016年政策实施前后门诊医疗费用资料,采用结构变动度法分析费用的结构变化情况。结果]次均药品费占比由政策实施前的47.10%上升至政策实施后的48.41%;政策实施后,西药费、检查费比重有所下降,化验费、中成药和中草药比重上升,药品费用比重出现上升趋势。结论]政策实施后,医疗费用增速变缓,药占比下降,但门诊次均费用呈逐年上升趋势,提示药品零差价政策对门诊患者医疗费用的控制作用不明显。建议进一步扩大医疗服务项目调整范围,提升医疗服务项目价格调整的精准度。

Empirical study on the change of out-patient medical expenditure under zero drug profit policy based on degree of structure variation

Objective This paper aims to analyze the collected information of out-patient medical expenditure structure variation after the implementation of zero drug profit policy in 12 county level general public hospitals from 2009 to 2016 in Ningxia so as to provide reference for perfecting the policy of zero drug profit.Methods It collected out-patient medical expenditure data before and after the implementation of zero drug profit policy.Degree of structure variation(DSV)was used to analyze the information of outpatient medical expenditure changes.Results The proportion of outpatients time-average drug costs increased from 47.10%before the implementation of the policy to 48.41%after the implementation of the policy.The proportion of western medicines and inspection fees decreased after the implementation of the policy,the proportion of testing fees,Chinese patent medicines,Chinese herbal medicines increased,and proportion of pharmaceutical costs showed rising trend.Conclusions After the implementation of the policy,the speed of medical expenditure shows down,the proportion of drug cost declines.But outpatients time-average costs shows rising trend year by year.It hints that is not obvious of effect of zero drug profit policy to the control of outpatient medical expenditure.It suggests that scope of adjustment and accuracy of medical service projects should be expanded further.