基于准试验设计的公立医院收入补偿情况分析 ——以山东省某三甲医院为例

doi:10.6040/j.issn.1671-7554.0.2019.014

摘要/Abstract

摘要： 目的通过分析山东省某医院收入结构变化,评价公立医院补偿机制改革对其的影响,并为进一步完善补偿机制改革提供政策建议。方法采用准试验研究设计即间断时间序列研究,以2016年6月公立医院补偿机制改革政策实施为干预点,月为单位,2014年1月至2016年5月为干预前,2016年6月至2017年12月为干预后,对山东省某省级综合三甲公立医院收入变化进行分析。结果每月药占比改革前后趋势变化为-0.124%,差异具有统计学意义(P<0.01);每月医疗服务收入占比改革前后趋势变化为0.146%,差异具有统计学意义(P<0.001);改革后化验(7.96%)和检查收入(9.91%)占比中位数增加(P<0.001);改革后卫生材料收入占比中位数(25.57%)增加(P<0.001)。结论实行补偿机制改革,有助于破除“以药养医”现象,提高医疗工作者的劳动价值。建议重点提高手术、护理等医疗服务价格,建立动态成本控制机制,提高医院内部管理能力。

关键词: 公立医院, 收入结构, 补偿机制改革, 准试验研究, 间断时间序列

Abstract: Objective To evaluate the effects of the compensation mechanism reform in public hospitals on the income structure and to provide references for policy making. Methods The quasi-experimental study design was a time series study analyzing the monthly income changes of a provincial comprehensive public hospital in Shandong Province. The time from Jan. 2014 to Jun. 2016 was taken as the pre-reform, while the period between Jun. 2016 and Dec. 2017 as the post-reform. Results The monthly trend changes of the percentage of income from drugs, and income from medical services before and after the reform was -0.124% and 0.146%, respectively, and the differences were statistically significant(both P<0.01). After the reform, the median proportion of income from laboratory tests, examinations and health materials increased to 7.96%, 9.91% and 25.57%, respectively(all P<0.001). Conclusion The reform of com- 山东大学学报 (医学版)57卷3期 -张璐,等.基于准试验设计的公立医院收入补偿情况分析——以山东省某三甲医院为例 \=-pensation mechanism is helpful to reduce the phenomenon of “feeding medicine with medicine” and enhance the labor value of medical workers. It is suggested that the prices of surgeries and nursing services should be raised, and a dynamic cost control mechanism should be established to improve the capacity of inner management.

Key words: Public hospitals, Income structure, Reform of the compensation mechanism, Quasi-experimental study, Interrupted time series

中图分类号:

R197

张璐,许敏旋,杨晓雪,贾莉英. 基于准试验设计的公立医院收入补偿情况分析 ——以山东省某三甲医院为例[J]. 山东大学学报 (医学版), 2019, 57(3): 109-114.

ZHANG Lu, XU Minxuan, YANG Xiaoxue, JIA Liying. An analysis of income compensation of public hospitals based on a quasi-experimental design ——a case study of a first-class hospital in Shandong Province[J]. Journal of Shandong University (Health Sciences), 2019, 57(3): 109-114.

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