杨练+李见+谭玲+熊新文+黄云霞

摘   要   目的：探讨新医改前后公立医疗机构次均费用变化趋势，为控制医疗费用不合理上涨提供依据。方法：对四川省公立医疗机构2007-2013年次均门诊费用、次均住院费用及变化趋势进行统计描述分析。结果：2007年以来全省公立医疗机构、公立医院和基层医疗卫生机构次均门急诊费用平均增长速度分别为11.30%、，12.03%和10.45%;次均住院费用平均增长速度分别为11.47%、10.78%和12.64%。药品费用是各类医疗机构次均费用主体，2012年后检查化验费用构成比下降而技术劳务费用构成比有所上升。结论：建议控制药品费用，推进支付方式改革，提高基层卫生机构服务能力，加强政府监管，促进公立医院良性发展以有效控制医疗费用过快上涨。

关键词    医疗费用    公立医疗机构    次均门诊费用    次均住院费用

中图分类号：R197.3            文献标识码：C            文章编号：1006-1533（2014）23-0062-05

Analysis of the medical expenses in the public medical institutions

of Sichuan Province from 2007 to 2013*

YANG Lian1**， LI Jian2， TAN Ling2， XIONG Xinwen2， HUANG Yunxia1

（1. School of Management， Chengdu University of Traditional Chinese Medicine， Chengdu 611137， China;

2. Department of Planning and Finance， Health and Family Planning Commission of Sichuan Province， Chengdu 610041， China）

ABSTRACT   Objective： To discuss the changing trend of the average expense in the public medical institutions before and after the new medical reform and provide a basis for controlling the unreasonable rise of medical expenses. Methods： The average expenses of outpatients and inpatients and their changing trend in the public medical institutions of Sichuan Province from 2007 to 2013 were statistically analyzed. Results： The average growth rates of the average expenses of outpatients and inpatients in the public medical institutions， the public hospitals or the community-level medical and health care institutions were 11.30%， 12.03% or 10.45% and 11.47%， 10.78% or 12.64%， respectively. Drug expense was the largest part of average expenses in all kinds of medical institutions. The constituent ratio of the examination and laboratory test expenses decreased while that of the technical services expenses rose after 2012. Conclusion： The measures， such as controlling the drug expenses， promoting the payment reform， improving the service capacity of the community-level medical and health care institutions and strengthening government supervision， should be taken to promote the benign development of the public medical institutions so as to effectively prevent medical expenses from rising too fast.

KEY WORDS    medical expenses; public medical institution; average outpatient expenses; average inpatients expenses

截至到2013年，新医改进行到第5年，不同医疗机构改革的进度和深度虽不一致，但都将共同面临着保险扩大、患者需求进一步释放、优质医疗资源需求增加、医疗技术进步、通货膨胀等多项变化，而这些变化均可能导致次均费用继续上涨。次均费用往往是卫生行政管理人员和卫生管理研究者用来衡量和评价医疗费用水平的指标。医疗费用如果增长过快，必然导致广大居民从保险扩大中获得的受益大打折扣。为探索新医改前后次均费用的变化趋势，本研究对四川省公立医疗机构2007-2013年次均门诊费用、住院费用进行分析，为进一步深化新医改提供政策参考依据。……