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目的探讨药品零差价政策实施后对四川省县级公立医院患者住院次均费用的影响,观察各影响因素的变动情况,提出应对相关变化的政策建议。方法对2010-2015年四川省县级公立医院住院次均住院费用数据进行灰色关联法和结构变动度分析,定量评价各年份住院费用各因素之间的关联程度和结构变动。结果在6年间次均住院费用增长31.68%,药品零差价政策实施后,药费的关联度最大(1.000 0),其次是以卫生材料费和化验费为主要构成的其他费用(0.888 8);结构变动贡献率中,其他费用(卫生材料费和化验费等)的结构变动贡献率最大(37.05%),其次是药费(23.91%),两者的累计贡献率为60.96%,是主要影响次均住院费用的因素。结论药品零差价政策,初见成效,药品费用占住院次均费用比例出现下降趋势,以卫生材料和化验费为主的其他费用增长明显,关联性强,结构变动贡献率大,整体变动结构不太合理,建议进一步完善药品零差价政策实施,控制其他费用增长,建立县级公立医院合理的激励和监管机制。
Objective To explore the impact of zero-difference drug policy on the average cost of hospitalization in county-level public hospitals in Sichuan Province after the implementation of the policy, observe the changes of various influencing factors and propose policy suggestions to cope with relevant changes. Methods Gray relational analysis and structural change analysis were performed on the data of inpatient per capita hospitalization costs in county-level public hospitals in Sichuan province from 2010 to 2015 to quantitatively evaluate the correlation and structural changes between various factors of hospitalization expenses in each year. Results The average cost of hospitalization increased by 31.68% in 6 years. After the implementation of Zero Difference Price policy, the most significant correlation was drug cost (1.000 0), followed by other expenses (0.888 8), mainly consisting of the cost of materials and testing. Among the contribution rates of structural change, the structural changes of other expenses (health materials fees and laboratory fees, etc.) contributed the most (37.05%), followed by medicine (23.91%), the cumulative contribution rate of both was 60.96% The average cost of hospitalization factors. Conclusions The drug zero difference policy has achieved initial success. The share of drug costs in the average cost of hospitalization shows a decreasing trend. Other expenses mainly based on health materials and laboratory tests have been significantly increased with strong correlation and large contribution to structural changes. Too reasonable, it is recommended to further improve the drug zero difference policy implementation, control of other cost increases, the establishment of county-level public hospitals reasonable incentives and regulatory mechanisms.