CAJ | 학술논문

目的：评价南京区级公立医院医药价格改革方案的合理性和可行性。方法：通过对南京市区级公立医院医药价格改革前后医疗费用数据的测算调研，模拟分析医保基金支出等重点指标的变化。结果：已试点的江宁区医院门诊和住院次均费用均下降，个人负担率住院持平、门诊有升有降。经模拟测算，即将推进改革的其它4个区级医院门诊和住院药占比、次均门诊费用均有所下降，次均住院费用上升，住院费用个人负担下降3.21个百分点，住院费用医保统筹基金增加支出占实际基金支出的7.74％。结论：医药价格改革减轻了患者个人负担；医保基金支出增加，风险有待防范；医药价格结构调整趋向合理，医疗技术和医护服务价值得到体现，补偿率偏高地区个人和医保统筹基金支出均增加。建议：破除“以药补医”机制，引导参保人员合理分流，推进医保支付方式改革，医保基金市级统筹、城乡统筹相结合，促进县级公立医院改革良性发展。
목적：평개남경구급공립의원의약개격개혁방안적합이성화가행성。방법：통과대남경시구급공립의원의약개격개혁전후의료비용수거적측산조연，모의분석의보기금지출등중점지표적변화。결과：이시점적강저구의원문진화주원차균비용균하강，개인부담솔주원지평、문진유승유강。경모의측산，즉장추진개혁적기타4개구급의원문진화주원약점비、차균문진비용균유소하강，차균주원비용상승，주원비용개인부담하강3.21개백분점，주원비용의보통주기금증가지출점실제기금지출적7.74％。결론：의약개격개혁감경료환자개인부담；의보기금지출증가，풍험유대방범；의약개격결구조정추향합리，의료기술화의호복무개치득도체현，보상솔편고지구개인화의보통주기금지출균증가。건의：파제“이약보의”궤제，인도삼보인원합리분류，추진의보지부방식개혁，의보기금시급통주、성향통주상결합，촉진현급공립의원개혁량성발전。
Objectives:This paper evaluates the rationality and feasibility of pharmaceutical price reform in dis-trict public hospitals in Nanjing .Methods:Pharmaceutical expense data before and after pharmaceutical price reform was collected from databases , changes of some major index about expenditures of medical insurance fund was simula -ted.Results:In Jiangning district hospital which had been reformed ,inpatient and outpatient expenses decreased while patient burden rate was the same or changed only slightly .Under the same stimulation , in four other district hospitals which is about to reform , the drug proportion of inpatient and outpatient and outpatient expenses per -time decreased , while inpatient expenses per-time increased .The hospitalization burden rate decreased by 3 .21%, and health insurance expenditure of inpatient accounted for 7 .74%of the whole fund pool .Conclusions:Pharmaceutical price reform reduced patient financial burden;health insurance fund spending increased and needs more attention in order to guard against the fund risk .The structure of pharmaceutical pricing tended to be reasonable and medical technology and medical service was more helpful .Compensation rates of medical insurance weren't equal, and the higher the compensation rates , the more both patient burden and health insurance fund expenditures were .Sugges-tions:It is crucial to eradicate the system of “subsidizing hospitals by charging more medicine fees” by leading the patient to primary medical situation , pushing the implementation of hospital payment reform and uniting of city inte-gration and urban-rural integration in order to ensure scientific development of district public hospitals .