公立医院 “成本病” 与医疗负担——兼论 “药品零加成” 政策的影响

公立医院是我国医疗卫生体系的主体,是新医改成功的关键,但多年来缺乏完善的成本核算体系,也加重了患者和政府的医疗负担。文章利用2013-2018年中部某省658家公立医院数据,基于Baumol"成本病"理论,构造新的"调整的鲍莫尔变量",首次从微观视角检验公立医院"成本病"的存在性,并考察了"成本病"是否加重了患者和政府负担;进一步结合"药品零加成"政策的实施,探究了其对公立医院"成本病"效应的影响。研究发现,我国公立医院系统同样存在"成本病"现象,且是加重患者与政府医疗负担的重要原因;"成本病"对患者医疗负担的影响并无医院等级差异,对政府医疗支出的影响在二级医院更为明显。结合样本期内"药品零加成"政策的实施发现,政策有效降低了患者负担,但加重了政府医疗支出,也未能缓解公立医院的"成本病"问题,但有助于医技成本支出的降低。研究具有重要的政策启示:"成本病"已经成为制约公立医院可持续发展的重要影响因素,亟需建立有效的成本核算管理工具和机制,健全公立医院薪酬制度,促进公立医院管理向精细化、规范化转型,抑制"成本病"问题,保障公立医院健康、可持续发展。

"Cost Disease" and Medical Burden in Public Hospitals-Discuss the Impact of the "Zero Markup Drug" Policy

Public hospitals are the main body of China's medical and health system and the key to the success of the new medical reform.However,the lack of a perfect cost accounting system for many years has also increased the medical burden of patients and the government.Using the data of 658 public hospitals in a Province in central China from 2013 to 2018,based on Baumol's "cost disease" theory,this paper constructs a new variable"adjusted Baumol "to test the existence of" cost disease"in public hospitals from the micro l evel for the first time.It also investigates whether the"cost disease"increases the burden on patients and the government,and for the first time explores the impact of the"cost disease"effect of public hospitals under the background of the implementation of the"Zero Markup Drug "policy.The study found that due to the human cost exceeding the productivity level,there is also a" cost disease"phenomenon in China's public hospital system,which is an important reason to increase the medical burden of patients and the government;The impact of "cost disease" on patients'medical burden has no difference in hospital level,and the impact on government medical expenditure is more obvious in secondary hospitals.Combined with the implementation of the"Zero Markup Drug "policy during the sample period,it is found that the policy effectively reduces the burden of patients,but increases the government's medical expenditure,and fails to alleviate the" cost disease"problem of public hospitals,but helps to reduce the cost of medical technology.The research has important policy implications: "cost disease" has become an important factor restricting the sustainable development of public hospitals.It is urgent to establish effective cost accounting management tools and mechanisms,improve the salary system of public hospitals,promote the fine and standardized transformation of public hospital management,curb the problem of "cost disease" and ensure the healthy and sustainable development of public hospitals.