目的 了解天津市北辰醫(yī)院取消藥品加成政策及“4＋7”集中采購對患者門診次均費用的影響。方法 運用結(jié)構(gòu)變動度分析和灰色關(guān)聯(lián)分析，2014—2019年下半年天津市北辰醫(yī)院患者門診各項費用結(jié)構(gòu)變動和關(guān)聯(lián)程度。結(jié)果 2014—2019年，2019年門診次均費用增幅0.57%，較2018年增幅明顯下降。中成藥費、化驗檢查費、化學(xué)藥費、體檢費構(gòu)成比變化對患者門診費用變動度的貢獻率較高，累計貢獻率達79.85%，除中藥飲片費用外其他藥品費用均成負性變動。門診次均費用中，治療費、化驗檢查費、中藥飲片藥費的關(guān)聯(lián)度較大，中成藥費、護理費、抗菌藥費的關(guān)聯(lián)度小。結(jié)論 政策實施發(fā)揮藥師價值，現(xiàn)政策初現(xiàn)成效，患者藥品費用下降，治療費及化驗檢查費占比有增加趨勢，患者次均費用增幅得到控制，切實降低患者就醫(yī)負擔(dān)。

Objective To investigate the impact of canceling drug addition policy and "4 + 7" centralized procurement on the average outpatient expenses of patients in Tianjin Beichen Hospital.Methods Using variation analysis and the grey relevancy analysis, the structural changes and correlation degree of outpatient expenses in Tianjin Beichen Hospital from the second half of 2014—2019 were analyzed.Results From 2014 to 2019, the average outpatient expenses in 2019 increased by 0.57%, significantly lower than that in 2018. The proportion of Chinese patent medicine fee, laboratory examination fee, chemical drug fee, and physical examination fee had a higher contribution rate to the variation of outpatient expenses, with an accumulative contribution rate of 79.85%. Except for the cost of traditional Chinese medicine, other drug costs showed negative changes. In the average outpatient cost, the correlation degree of treatment fee, laboratory examination fee, and Chinese herbal medicine cost is larger, while that of Chinese patent medicine, nursing fee and antibacterial drug fee is small.Conclusion Policy implementation to give full play to the value of pharmacists. The policy has achieved initial results, the drug cost of patients has decreased, the proportion of treatment fee and laboratory examination fee has an increasing trend, the increase of average cost of patients has been controlled, and the medical burden of patients has been effectively reduced.

R952

天津市北辰區(qū)科技發(fā)展計劃項目（2018-SHGY-08）