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目的 揭示政策对三甲医院经营行为的导向、存在的问题，为新一轮改革进程中有关三甲医院相关政策的制定提供实证依据。方法 回顾性统计描述分析上海10所三甲医院1997—2006年收益变化趋势及其影响因素。结果 （1）1999—2004年平均药品加成率持续快速递增，由13.0%跃升至30.9%，但2004年之后开始下降。（2）万元医疗收入卫生材料支出总体呈现增长趋势，卫生材料支出占医疗收入比重由1997年19.0%升至2006年29.3%；平均人员经费支出占业务收入比重经1999年跃升后维持在27%～30%之间。（3）1999年以来，10所医院平均医疗收入支出比从未超过1.00,总体呈略降趋势，反映医疗服务亏损率增加；同时，药品收入支出比一直维持在1.10以上且呈上升趋势，反映药品利润率增加。2004年后药品收支比呈下降趋势，在时间上与药品集中招标采购政策实施相吻合。（4）平均业务收入结余率、净资产结余率从未超过9.0%，2006年经费自给率低于100%。结论 （1）由于对医院实行“以药养医”补偿机制，为了维持盈亏平衡，医院是以不断增加的药品盈利来弥补不断增加的医疗服务的亏损，致使医院对药品依赖不弱反强。（2）在药品占医院收入比重受制于政策导向不断下降情况下，医院通过不断提高药品加成率来扩大药品盈利，但2004年上海开始实施药品集中招标采购等政策，抑制了医院药品加成率的增长趋势，导致药品盈利减少，最终将打破以药品盈利弥补医疗服务亏损的平衡。（3）医院经营状况呈现收入与资产快速递增，但医疗服务与药品收入结构没有显著改善，且医护人员工作负荷不断加重的趋势。 |
| 关键词: 三级甲等综合性医院 收益变化趋势 收益分析 |
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| Analysis of the Trend of Benefit Structure and its Influencing Factors of the Public Tertiary General Hospitals in Shanghai |
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| Abstract: |
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Objective To reveal the influence for operational behavior of the public tertiary hospitals by the medical policies and market in terms of the benefit structure. Methods Retrospective analysis of the benefit structure and its factors of the ten public tertiary general hospitals in Shanghai from1997 to 2006 has been done. Results The practical yearly averaged drug profit rate of the hospitals has been increased rapidly from 13.0% to 30.9% in 2004, and trends to decrease after 2004 which coincides in the practice of intensively purchasing for hospitals’ drugs by government. The ratio of the material cost to service revenue trends to increase from 19.0% in 1997 to 29.3% in 2006 . The ratio of per capita manpower cost to per capita hospital revenue maintains a high level between 27% and 30% during the period of 2001 and 2006. The ratio of revenue to cost of service of each tertiary hospital has never been more than 1.00 since 1999 and trends to decrease slightly. In the meantime, the ratio of revenue to cost of drug has always been more than 1.10 and increases before 2004. The naked assets balance rate and the revenue balance rate always fluctuates below 9.0%. The expense self-support rate is always fewer than 9.0% and even below 100% in 2006. Conclusion The hospitals rely on drugs more than ever before，because the remuneration method “Offset Loss of Medical Services with Profit of Drugs” has never changed. From 2004 onwards，such balance appears being broken with the introduction of the policy “Concentrated Bidding Purchases of Medicine System”，which aims at declining drug profit.The benefit structure of these hospitals appears being worse accompanied by the rapid growth of the total revenue. |
| Key words: the public tertiary general hospital, benefit trend, benefit analysis |
