我国县级公立医院取消药品加成补偿政策的合理性研究
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篇名: 我国县级公立医院取消药品加成补偿政策的合理性研究
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摘要: 目的:评价我国县级公立医院取消药品加成补偿政策的合理性,为破除“以药补医”机制提供参考。方法:收集2015年8月1日前我国30个省、自治区、直辖市(简称“省市”)政府办公厅及政府相关部门官方网站中有关县级公立医院取消药品加成政策的文件,对县级公立医院取消药品加成的取消进度、补偿模式、补偿基数、补偿范围、补偿途径及补偿率、财政补偿方式等6个维度进行分析。结果:有46.67%的省市完全取消了药品加成政策;绝大多数省市采取“取消多少,补偿多少”的补偿模式;有54.55%的省市以2011年或取消药品加成前1年的药品加成收入财务数据作为补偿基数;有93.33%的省市由调整医疗服务价格补偿,有86.67%的省市由政府财政补偿,有50.00%的省市由医院加强成本控制自身消化;完全取消药品加成省市的财政补偿率是未完全取消省市的1.72倍,未完全取消省市调整医疗服务价格补偿率是完全取消省市的1.22倍;取消药品加成财政补偿方式主要有按常住人口和按绩效考核结果补偿2种类型。结论:财政补偿率高低同药品加成政策取消进度呈高度正相关;医疗服务价格调整补偿途径承担了补偿的主体责任;取消药品加成政策实施现状与取消药品加成政策目标不相适应。建议建立分步分类的医疗服务价格调整机制及以区域卫生规划为导向的差异化财政投入机制。
ABSTRACT: OBJECTIVE: To evaluate the rationality of cancelling drug addition compensation strategy in county-level public hospitals in China, and to provide reference for abolishing the system of “drug-maintaining-medicine”. METHODS: The documents about cancelling drug addition strategy in county-level public hospitals were collected from websites of 30 provincial, autonomous region and municipality (called “province and city” for short) general office and related governmental departments before Aug. 1st, in 2015. The cancelling drug addition strategy in county-level public hospitals was analyzed in respects of rate of progress, compensation mode, compensation radix, compensation range, compensation channel and compensation rate, financial compensation way. RESULTS: 46.67% provinces and cities completely cancelled drug addition strategy; the compensation mode of canceling drug addition was “how much to cancel,how much to compensate” in the vast majority of provinces and cities; drug addition income financial data in 2011 or the year before cancelling drug addition strategy were used as compensation radix in 54.55% provinces and cities; compensation way included adjusting medical service price in 93.33% provinces and cities, government finance compensation in 86.67%, and strengthening hospital cost control and digesting cost by hospital in 50.00%. The rate of financial compensation in provinces and cities which had cancelled drug addition strategy completely was 1.72 times as much as those had not cancelled drug addition strategy completely; the rate of adjusting medical service price in provinces and cities which had not cancelled drug addition strategy completely was 1.22 times as much as those had cancelled drug addition strategy completely. Financial compensation way mainly included compensating by resident population and by performance appraisal result. CONCLUSIONS: The rate of financial compensation is highly positively correlated with rate of progress; compensation channel of adjusting medical service price takes subject responsibility; the situation of cancelling drug addition strategy doesn’t adapt to strategy purpose. It is suggested to establish step by step and classified medical service price adjustment system and local health plan-oriented differentiated financial input mechanism.
期刊: 2016年第27卷第10期
作者: 谭华伟,阳光,颜维华,刘宪,郑万会,张云,朱小玲,张培林
AUTHORS: TAN Huawei,YANG Guang,YAN Weihua,LIU Xian,ZHENG Wanhui,ZHANG Yun,ZHU Xiaoling,ZHANG Peilin
关键字: 县级公立医院;以药补医;药品加成;补偿政策
KEYWORDS: County-level public hospitals; Drug-maintaining-medicine; Drug addition; Compensation strategy
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