China Center for Health Development Studies, Peking University, Beijing, China.
School of Management, Beijing University of Chinese Medicine, Beijing, China.
BMJ Open. 2019 Aug 10;9(8):e029646. doi: 10.1136/bmjopen-2019-029646.
To evaluate the 2017 implementation of China's 2009 healthcare price reforms on Beijing's secondary and tertiary traditional Chinese medicine (TCM) hospitals.
We employed a panel-interrupted time-series model with hospital fixed effects to estimate the impact of the price reforms.
Beijing, April 2014 to April 2018.
All TCM hospitals in Beijing.
Our dependent variables comprised the monthly outpatient and inpatient revenues, the number of monthly outpatient visits and inpatient admissions, the average total expenditures per outpatient visit and per inpatient admission, the average drug expenditures (except herbal medicines) per outpatient visit and per inpatient admission and the average medical service expenditures per outpatient visit and per inpatient admission.
In tertiary hospitals, the price reforms led to significant reductions in the number of outpatient visits (23.1%), inpatients admission (4.6%) and drug expenditures (except herbal medicines) per inpatient admission (14.0%), and an instant raise in average total expenditure per outpatient (22.0%), medical service expenditures per outpatient visit (58.2%) and inpatient admission (19.0%). There was no significant association between the price reforms and the monthly outpatient and inpatient revenues. After the price reforms, the previous upward trend in medical service expenditures per outpatient visit rose more sharply (from 0.5% to 1.6%). In secondary hospitals, the price reforms decreased the level of drug expenditures (except herbal medicines) per outpatient visit (13.0%) and per inpatient admission (20.8%), but increased medical service expenditures per inpatient admission by 19.0%.
The Beijing price reforms adjusted the cost structures in secondary and tertiary TCM hospitals without negatively impacting the operation of the hospitals, and through the increased hierarchical medical service fee, shifted patient choices away from tertiary to other health facilities, especially for patients with minor illnesses.
评估中国 2009 年医疗价格改革在 2017 年对北京市二级和三级中医（TCM）医院的实施情况。
我们采用面板中断时间序列模型和医院固定效应来估计价格改革的影响。
北京，2014 年 4 月至 2018 年 4 月。
北京市所有 TCM 医院。
我们的因变量包括每月门诊和住院收入、每月门诊和住院就诊人数、每门诊就诊平均总支出、每住院就诊平均总支出、每门诊就诊平均药品支出（草药除外）和每住院就诊平均药品支出（草药除外）以及每门诊就诊平均医疗服务支出和每住院就诊平均医疗服务支出。
在三级医院，价格改革导致门诊就诊人数（23.1%）、住院就诊人数（4.6%）和住院就诊人均药品支出（草药除外）（14.0%）显著减少，以及门诊就诊人均总支出（22.0%）、门诊就诊人均医疗服务支出（58.2%）和住院就诊人均医疗服务支出（19.0%）即时增加。价格改革与每月门诊和住院收入之间没有显著关联。价格改革后，门诊就诊人均医疗服务支出的上升趋势更加明显（从 0.5%上升至 1.6%）。在二级医院，价格改革降低了门诊就诊人均药品支出（草药除外）（13.0%）和住院就诊人均药品支出（草药除外）（20.8%），但增加了住院就诊人均医疗服务支出（19.0%）。
北京市价格改革调整了二级和三级 TCM 医院的成本结构，而没有对医院的运营产生负面影响，并通过提高分级医疗服务费用，将患者选择从三级医院转移到其他医疗机构，特别是对于小病患者。
