A Study On The Effect Of Zero Drug Price Difference Policy On The Medical Expenses Of Inpatients In Tertiary Hospitals

Research purpose and meaning: Take an A-grade hospital in Liaoning province as an example,through the analysis of medical expenses of inpatients,the internal structure of medical expenses of inpatients,the influencing factors of medical expenses of inpatients before and after the implementation of zero drug price difference policy,and the stakeholder analysis of zero drug price difference policy.we can understand the changes of the medical expenses of inpatients,and explore the unreasonable part of the medical expenses of inpatients and the problems in the implementation process of zero drug price difference policy,provide suggestions for further improving zero drug price difference policy,and rationally controlling the increase of the medical expenses.Methods: the inpatients from an A-grade hospital in Liaoning province were selected as the research objects.The interrupted time series analysis method is used to describe the change of average medical expenses of per inpatient before and after zero drug price difference policy.The degree of structure variation is used to analyze the internal composition of medical expenses for inpatients and inpatients with representative diseases in different departments that have changed before and after the implementation of zero drug price difference policy.Application of multiple linear regression is used to analyze the changes of influence factors of medical expenses of inpatients before and after the implementation of zero drug price difference policy.Results:(1)in the first month after the implementation of zero drug price difference policy,the average medical expenses,average drug expenses,average laboratory expenses and average examination expenses of inpatients were all decreased to different degrees.However,with the passage of time,the average drug expenses changed from the downtrend before the policy was implemented to an uptrend,and the average drugexpenses showed an obvious uptrend compared with that before the policy was implemented,and was gradually higher than that before the policy was implemented.(2)after the implementation of zero drug price difference policy,the degree of change in the medical expenses structure of inpatients was 14.40%;Drug and laboratory expenses changed negatively,while material,operation,nursing,diagnosis,treatment,examination,bed and other expenses changed positively.(3)after the implementation of zero drug price difference policy,the average medical expenses for medical diseases decreased significantly,the average medical expenses for surgical diseases decreased slightly,and the average medical expenses for gynecological diseases increased significantly.The change of the internal structure of medical diseases was higher than surgery and gynecology diseases.The proportion of medicine in medical diseases was higher than surgery and gynecology diseases.the largest increase of surgery and gynecological diseases is the rate of surgery expenses,the largest increase of medical diseases is the rate of treatment expenses.(4)the factors affecting the medical expenses of inpatients before and after the implementation of zero drug price difference policy were almost the same,including whether the inpatient received surgical treatment,length of stay,whether there were complications,whether they were hospitalized for the first time,and the proportion of drugs.The proportion of medicine expenses decreased after zero drug price difference policy,and the regression coefficient decreased from0.009 to 0.003.(5)the stakeholders of zero drug price difference policy mainly include:the government,public hospital,medical personnel,medical enterprises and inpatients.Research conclusion:(1)effect of the zero drug price difference policy was good in the short term,average medical expenses of inpatients were effectively controlled.with the implementation of the policy after a period of time,the average drug expenses and the average examination expenses of inpatients showed an increasing trend,the behavior of using drug and checking needs to be standardized.(2)zero drug price difference policy played a positive role in optimizing the medical expenses structure of inpatients.The proportion of drugs expenses has been greatly reduced,and the nursing expenses,operation expenses and diagnosis expenses which reflect the labor value ofmedical personnel,have increased in the proportion of inpatients' medical expenses,but the increase is small.(3)the proportion of examination expenses in medical expenses is increasing instead of decreasing,The variation degree of medical expenses structure of diseases in different departments is different.Medical diseases are obviously higher than surgery and gynecology diseases,and the ability to adjust medical expenses structure of medical diseases by zero drug price difference policy than surgery and gynecology diseases.(4)the medical expenses of inpatients are affected by various factors before and after the implementation of zero drug price difference policy,and effective measures should be taken for the length of stay,whether there are complications,whether there is surgical treatment,whether there is a first hospitalization and the proportion of drugs to curb the growth of medical expenses of inpatients.Countermeasures and Suggestions:(1)further strengthen the control of drug expenses,and effectively implement zero drug price difference policy;(2)optimize the structure of medical service expenses by taking the "tripartite system reform" as the starting point;(3)establish a flexible compensation mechanism and improve the hospital performance evaluation system;(4)strengthen the public prevention of “early detection,early diagnosis and early treatment”,strengthen clinical path management;(5)strengthen the linkage supervision strategy among stakeholders.