The Effect Of Drug Zero-addition Policy On Hospitalization Cost In A Public Hospital In Guangxi

ObjectiveTo compare the effect of eliminating drug addition on the hospitalization cost of a public hospital in guangxi,and to analyze the impact of zero-addition policy on medical expenses from different inpatient departments of internal medicine,surgery,obstetrics and gynaecology,and pediatrics.Exploring the problems existing in the current zero-plus policy reform of drugs.And put forward corresponding policy recommendations to provide decision-making reference for relevant medical and health departments.MethodsThe data of this study are from inpatient medical records.In this study,four public hospitals in a certain city of Guangxi were selected as research objects,descriptive statistics and structural change methods were used to analyze the composition and changes of hospitalization expenses before and after the zero-plus policy of public hospitals in a city in Guangxi.Finally,the GM(1,1)gray prediction model was used to calculate the average hospitalization expenses and the average drug costs.Predictive analysis.Results(1)After the drug addition was cancelled,the average hospitalization expenses of internal medicine and pediatrics in public hospitals in a certain city of Guangxi decreased,the average hospitalization expenses of internal medicine decreased by 9.15%,and the pediatrics decreased by 3.95%.The average hospitalization costs for surgery and obstetrics and gynaecology increased slightly,the average surgical cost increased by 1.80%,and the average cost of obstetrics and gynaecology increased by 2.17%.Among the various indicators of hospitalization expenses,the average drug costs of internal medicine,surgery,obstetrics,and pediatrics all declined to varying degrees.Among them,the average medical cost of surgery decreased by 41.85%,which was in line with the expected effect of the policy;the average comprehensive service fee and average consumables fee all showed an increasing trend;Except for the average diagnostic cost of obstetrics and gynecology increased by 3.74%,the average diagnostic cost of internal medicine,surgery and pediatrics increased;except for the average medical treatment cost decreased by 9.53%,the average diagnostic cost of surgery,obstetrics and gynecology and pediatrics increased;the average consumable cost continued.rise.The overall hospitalization fee structure tends to be rationalized.(2)The top three items of the average hospitalization cost contribution rate of public hospitals in a city in Guangxi in 2013-2017 were drug costs(35.98%),consumables(28.34%),and comprehensive service fees(18.04%).The cumulative contribution rate reached 82.36%,which was the main factor leading to the change in the average cost structure of hospitalization in 5 years.After the cancellation of drug add-on,the proportion of the average diagnostic fee,treatment fee,and drug fee of public hospitals in a certain city of Guangxi declined to varying degrees,and the average cost of drug fees decreased the most.The impact of drug costs on hospitalization costs has Resultsdeclined year by year,from 33.80% in 2013 to 22.73% in 2017.After canceling the drug addition,the composition ratio of western medicine fee decreased by 3.84%,and the composition ratio of Chinese herbal medicine fee decreased by 3.38%.The composition ratio of western medicine fee decreased the most.It should be noted that although the cost of medicine decreased,Chinese patent medicine The proportion of public hospitals in a certain city in Guangxi is basically unchanged from that before the implementation of the policy.The GM(1,1)model is used to predict the medical expenses of China in 2018-2022.The average hospitalization expenses of patients in public hospitals in a city in Guangxi are estimated to be 5,509.21 yuan,5,315.89 yuan,5,219.35 yuan,4,949.35 yuan,and 4,775.68 yuan in 2018-2022,and the average hospitalization expenses are decreasing year by year.It is predicted that a public hospital in a certain city of Guangxi The average drug cost of patients was 1168.58 yuan,1068.87 yuan,977.67 yuan,894.24 yuan,and 817.94 yuan in 2018-2022,and the average drug cost showed a downward trend year by year,but the rate of decline gradually decreased.Conclusion(1)The zero-addition policy of drugs has a certain control effect on the hospitalization expenses of public hospitals in a certain city of Guangxi,so that the total hospitalization expenses of inpatients are controlled at a relatively stable level.(2)After the drug addition is cancelled,the drug cost has shown a certain downward trend.The implementation of the zero-plus-product policy has achieved initial results,while the proportion of comprehensive service fees and consumables has increased,reflecting the labor value of medical staff..(3)The hospitalization expenses of different departments are not the same,each has its own characteristics,and the formulation of hospital implementation rules will be more conducive to differentiated management.(4)The proportion of Chinese patent medicines in internal medicine,surgery and pediatrics has increased to varying degrees.This aspect may be related to the development of Chinese medicine in China.On the other hand,it may be that Chinese patent medicines are not listed in the drug elimination policy.In the fee-controlled list,doctors tend to open more Chinese-made drugs under the influence of interests.Before and after the cancellation of drug addiction,gender,age,type of medical insurance,number of hospital stays,and number of hospitalizations are all factors influencing hospitalization expenses.These factors should be taken to further curb the increase in hospitalization expenses.(6)According to the results of the forecasting model,under the existing policy conditions,hospitalization expenses will be further reduced,and drug costs will also decline,but the rate of decline will gradually slow down,and should be strengthened in the future policy formulation process.Recommendations: Strengthen the control of drug costs,fully implement the zero-addition policy for drugs;optimize the structure of medical service fees,and effectively control the cost of hospitalization;use the "three-medical linkage" as the entry point to enhance the comprehensiveness and synergy of the reform;carry out clinical pharmacy services and use drugs rationally.