RESUMEN
Objective:To empirically evaluate the impact of the reform of separating drug sales from medical services reform on the operation of public hospitals in Beijing. Methods:Taking R hospital as a case study,Twenty-six clinical departments were selected as samples, and the indicators which have significant change after medical reform were analyzed by descriptive statistics,Pairing test,Correlation test and Spearman correlation test. 24 tested indicators included workload,cost and medication behavior. Results:After the Beijing medical reform between May to September 2017,and from May to September 2016, R hospital workload and cost indicators changed in varying degrees. There were differences between the two groups in terms of the internal medicine and surgery,and the medi-cation behavior had no significant change. Conclusion:The effect of Beijing's healthcare reform policy is obvious. R hospital has the trend of decreasing outpatient volume, drug proportion and medical insurance costs. The medical reform policy may have a profound impact on the development of the clinical subject.
RESUMEN
Objective:To evaluate the impact and analyze the mechanism of separating drug sales from medical services reform on the total medical expenditure containment of outpatient services in Beijing. Methods:The monitoring data and historical data from 89 third-level,78 second-level public hospitals,and 206 primary health institutions and community health service agencies,which participated in the reform,were analysed to estimate the impacts on outpa-tient service utilization and service price. The analysis was based on the data of the first and second quarters of 2016 outpatient and emergency department fee changes,and analysis of service utilization and service price factors on the im-pact of changes in outpatient and emergency services mechanism. Results:The total outpatients'expenditure in Beijing in the second quarter of 2017 was 17.38 billion yuan,representing a slight decrease of 1.14% than the expenditure in 2016. The growth rate reduced by 2.46%. Expenditure in third-level and second-level hospitals decreased by 2.82% and 3.02%,respectively,with reductions in growth rates of 4.06% and 3.74% respectively. Expenditure in primary institutions increased by 17.09%. The increase rate in the second quarter of 2017 was 26.28%,representing a remark-able increase compared to the rate in 2016(15.84%). The contribution from the medical institution service prices and service utilization to the change of outpatient and emergency medical expenditure containment was 6.98% and -7. 65%,respectively. For third-level hospitals,the contribution was 10.37% and -12.00%,respectively;second-level hospitals were 0.72% and -3.35%,respectively;and the primary health institutions was 6.08% and 9.57%. Con-clusions:Beijing's comprehensive reform of separating drug sales from medical services reform has effectively controlled the rising medical expenditure of outpatient services,mainly by adjusting outpatients service utilization between differ-ent level healthcare institutions.