Influence of separating medical treatment and drug sales reform on changes of medical expenses structure in patients covered by basic healthcare insurance

Objective To explore the impact of separating medical treatment and drug sales reform on the structural changes of medical expenses for basic healthcare insurance covered patients in a tertiary hospital. Methods A retrospective comparative study was conducted on the cost of basic healthcare insurance covered patients before and after the medical reform in a tertiary hospital in Beijing.Based on descriptive statistical analysis,index of structural change value,degree of structure variation and structural contribution rate were calculated to investigate the structural changes in medical costs. Results After medical reform,the outpatient(emergency)volume of basic healthcare insurance covered patients in this hospital dropped by 1.11%,while the hospitalization and surgical volume increased by 4.78% and 3.43% respectively,and the average hospitalization days decreased 0.28 days.The percent of medical expense for prescription drugs decreased by 5.41%,inspection fees decreased by 1.23%,labor cost reflecting the value of medical staff's services increased by 7.35%.The cost of drug,medical examination,consumptive material,inspection and treatment accounted for 90.67% of the total cost change.The average medical cost per visit for outpatient and the average cost per hospital stay for inpatient both increased to some extent. Conclusion After reform,the medical service for inpatient in the tertiary hospitals is strengthened,the medical cost structure of patients with basic healthcare insurance tends to be reasonable,the proportion of drug revenue reduces significantly and the labor value of medical staffs is emphasized.The time or dosage limits on the prescribing may lead to an increase in medical service fees which will bring a heavier burden to outpatients.Since the ratio of consumptive material cost to total cost is still high,and the laboratory test cost has grown rapidly,close attention should be paid to them.