目的 根据公立医院“取消药物加成”的改革目标,重点分析我院门诊总费用的结构及门诊药占比,为军队医院参与城市公立医院改革提供决策依据。方法 收集武警江苏总队医院2005-2015年门诊就诊人次,采用SAS 9.3软件及STATA 12对次均门诊费用、次均药物费用、药占比进行数据分析并进行研究。结果 (1)门诊总费用中药物费用所占比例最高,为38.0%,11年间大致呈现“凹”型趋势,其次为检查费27.0%,且呈现逐年递增趋势;(2)2005-2015年各年门诊药占比均低于当年统计年鉴公布的数据,即低于国家同期平均水平,且药占比上升趋势无统计学意义(Z=-1.39,P=0.164);(3)男、女患者次均药物费用均呈现缓慢增长趋势,且男性患者次均药物费用、药占比分别为101.3元和35.1%,高于女性患者的78.7元和30.8%,男、女患者门诊药费差异有统计学意义(Z=-49.1429,P<0.0001);(4) 60岁及以上患者次均药物费用、药占比最高,分别为118.6元和38.7%,35~59岁年龄组患者次均药物费用年均增长率最快,不同年龄组患者的门诊药费差异有统计学意义(χ²=4206.1403,P<0.001)。结论 该院根据实际情况制定的政策起到了控制药占比的作用,但药费仍持续上涨,可借鉴采取“三医联动”形式控制药物费用,并将军队医院纳入地方医改,这是促进其持续发展源动力。

Objective To study the structure of outpatients' expenses and the percentage of medicines in the total expenses for outpatients in a military hospital in order to provide evidence for the participation of military hospitals in the reform of urban public hospitals.Methods All the outpatients treated in this hospital between 2005 and 2015 were investigated. Descriptive analysis was performed using SAS 9.3 and STATA 12. The main indexes included mean expenses, mean drug expenses and the proportion of drug expenses.Results ① Drug expenses accounted for 38.0% of the total expenses for outpatients, ranking first and showing a concave shape over eleven years, followed by examination expenses that accounted for 27.0%. ②The proportion of drug expenses in this period was lower than in the corresponding data provided by the Chinese Health Statistics Yearbook. The trend of increase of drug proportions did not differ significantly(Z=-1.39,P=0.164).③The mean drug expenses increased slowly among men and women alike. The mean drug expenses(CNY 101.3) and percentage of drug expenses(35.1%) of men were higher than those of women, which were CNY 78.7 and 30.8%,respectively. There was significant difference (Z=-49.1429,P<0.0001)in drug expenses between the two groups. ④The mean drug expenses and percentage of drug expenses were the highest among elders above 60, which were CNY118.6 and 38.7%, respectively. There was significant difference in drug expenses between different age groups(χ²=4206.1403,P<0.001).Conclusions The effort of this hospital to control the proportion of drug was effective, but drug expenses kept increasing for eleven years. The joint reform of health care, medicines and medical insurance can help to control drug expenses and involve military hospitals in the reform of urban public hospitals, which will promote sustained development of hospitals.