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Article(id=1322590095270589323, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202406445, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1719158400000, receivedDateStr=2024-06-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793259651248, onlineDateStr=2026-10-29, pubDate=1736438400000, pubDateStr=2025-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793259651248, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793259651248, creator=13701087609, updateTime=1793259651248, updator=13701087609, issue=Issue{id=1322589954702688372, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='1736438400000', pubDateStr='2025-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793259617734, creator='13701087609', updateTime=1793260023378, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322591656147276425, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322591656147276426, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=108, endPage=113, ext={EN=ArticleExt(id=1322590095748739980, articleId=1322590095270589323, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The impact of the separation of medicine and pharmacy and the integrated reform of medical expenses on medical service revenue and its structure in a district of Beijing: an empirical study based on RDiT, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the impact of the separation of medicine and pharmacy and the integrated reform of medical expenses on medical service revenue in a district of Beijing.

Methods

Utilizing monitoring data from January 2016 to April 2024, a time breakpoint regression model was constructed for analysis.

Results

Following the implementation of the separation of medicine and pharmacy reform, the proportion of medical service revenue and the average medical service revenue per visit in secondary and tertiary hospitals significantly increased (P<0.05). After the implementation of the integrated reform of medical expenses, the average medical service revenue per visit and the proportion of service revenue in secondary hospitals also saw significant increases (P<0.05).

Conclusion

After reform, the total amount and proportion of medical service revenue have significantly increased, with further optimization of the revenue structure and a more adequate reflection of the value of technical services. However, the proportion of medical service revenue remains relatively low. It is recommended to enhance the reform linkage mechanism, strengthen the supervision of medical services, promote the balanced distribution of medical resources, and focus on improving the service capacity of primary healthcare institutions.

, authors=Hui YANG1, 2, authorsList=Hui YANG, authorCompany=null, correspAuthors=Hui YANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322590100781904793, articleId=1322590095270589323, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=医药分开与医耗联动综合改革对北京市某区医疗服务收入及其结构的影响——基于RDiT实证研究, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

分析医药分开和医耗联动综合改革对北京市某区医疗服务收入的影响。

方法

利用2016年1月—2024年4月的监测数据，构建时间断点回归模型进行分析。

结果

医药分开改革实施后，二、三级医院的医疗服务收入占比和门急诊次均医疗服务收入得到显著提升（P<0.05）。医耗联动改革实施后，二级医院门急诊次均医疗服务收入和服务收入占比得到显著提升（P<0.05）。

结论

改革实施后医疗服务收入总量和占比得到显著提升，收入结构进一步优化，技术劳务价值得到更加充分体现。但医疗服务收入占比还比较低，建议完善改革联动机制，强化医疗服务监管，推动医疗资源均衡分布，重点加强基层医疗机构服务能力提升。

, authors=杨辉1, 2, authorsList=杨辉, authorCompany=null, correspAuthors=杨辉, authorNote=

杨辉（1984—），男，硕士，副研究员，研究方向：卫生政策评估

, correspAuthorsNote=
杨辉，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=L7rK9UcYO6/sLXQVDNwDHQ==, magXml=6o/8mklSnwdEd1UECT69nA==, pdfUrl=null, pdf=GxqSXJxh71qhm8S1gU+9/Q==, pdfFileSize=808105, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=qRBjNbFmJZTobyKvZWemRA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=jtcIhg2HPUWsmA1Tt1PyMw==, mapNumber=null, fund=null)}, authors=[Author(id=1322590102916805536, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=237288608@qq.com, emailSecond=null, emailThird=null, correspondingAuthor=1, authorType=1, ext={EN=AuthorExt(id=1322590103034246051, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, authorId=1322590102916805536, language=EN, stringName=Hui YANG, firstName=Hui, middleName=null, lastName=YANG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, 2, address=Shunyi District Hospital, Beijing 101300, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322590103210406820, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, authorId=1322590102916805536, language=CN, stringName=杨辉, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, 2, address=1.北京市顺义区医院，北京 101300
2.北京市顺义区卫生和健康委员会，北京 101300, bio={"content":"

杨辉（1984—），男，硕士，副研究员，研究方向：卫生政策评估

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杨辉（1984—），男，硕士，副研究员，研究方向：卫生政策评估

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Chinese Hospital Management, 2021, 41(4):47-51.(In Chinese), articleTitle=Research on the impact of medical service price adjustment on the income structure of public hospitals: based on compositional data analysis, refAbstract=null), Reference(id=1322590109652857806, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, doi=null, pmid=null, pmcid=null, year=2021, volume=null, issue=7, pageStart=79, pageEnd=82, 164, url=null, language=null, rfNumber=[11], rfOrder=17, authorNames=李风芹, 田立启, 季金凤, journalName=价格理论与实践, refType=null, unstructuredReference=李风芹，田立启，季金凤. 医疗服务价格改革对公立医院收入结构影响研究——以青岛市公立医院改革为例[J]. 价格理论与实践，2021，（7）：79-82, 164., articleTitle=医疗服务价格改革对公立医院收入结构影响研究——以青岛市公立医院改革为例, refAbstract=null), Reference(id=1322590109740938191, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, doi=null, pmid=null, pmcid=null, year=2021, volume=null, issue=7, pageStart=79, pageEnd=82, 164, url=null, language=null, rfNumber=[11], rfOrder=18, authorNames=Li FQ, Tian LQ, Ji JF, journalName=Price:Theory & Practice, refType=null, unstructuredReference=Li FQ, Tian LQ, Ji JF. Research on the impact of medical service price reform on the income structure of public hospitals——take the public hospital reform in qingdao as an example[J]. Price:Theory & Practice, 2021, (7): 79-82, 164.(In Chinese), articleTitle=Research on the impact of medical service price reform on the income structure of public hospitals——take the public hospital reform in qingdao as an example, refAbstract=null), Reference(id=1322590109808047056, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, doi=null, pmid=null, pmcid=null, year=2024, volume=17, issue=3, pageStart=1, pageEnd=9, url=null, language=null, rfNumber=[12], rfOrder=19, authorNames=王文娟, 梁娟娟, 胡洋溢, journalName=中国卫生政策研究, refType=null, unstructuredReference=王文娟，梁娟娟，胡洋溢，等. 基于合成控制法的DRG改革对住院费用的影响--以北京市三级公立医院为例[J]. 中国卫生政策研究，2024，17（3）：1-9., articleTitle=基于合成控制法的DRG改革对住院费用的影响--以北京市三级公立医院为例, refAbstract=null), Reference(id=1322590109891933137, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, doi=null, pmid=null, pmcid=null, year=2024, volume=17, issue=03, pageStart=1, pageEnd=9, url=null, language=null, rfNumber=[12], rfOrder=20, authorNames=Wang WJ, Liang JJ, Hu YY, journalName=Chinese Journal of Health Policy, refType=null, unstructuredReference=Wang WJ, Liang JJ, Hu YY, et al. The impact of DRG on hospitalization costs based on synthetic control method: Take Beijing's tertiary public hospitals as an example[J]. Chinese Journal of Health Policy, 2024, 17(03):1-9.(In Chinese), articleTitle=The impact of DRG on hospitalization costs based on synthetic control method: Take Beijing's tertiary public hospitals as an example, refAbstract=null), Reference(id=1322590111573849042, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, doi=null, pmid=null, pmcid=null, year=2022, volume=15, issue=1, pageStart=2, pageEnd=10, url=null, language=null, rfNumber=[13], rfOrder=21, authorNames=代涛, journalName=中国卫生政策研究, refType=null, unstructuredReference=代涛“. 以人为中心”整合型医疗健康服务体系的关键要素研究[J]. 中国卫生政策研究，2022，15（1）：2-10., articleTitle=以人为中心”整合型医疗健康服务体系的关键要素研究, refAbstract=null), Reference(id=1322590111674512339, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, doi=null, pmid=null, pmcid=null, year=2022, volume=15, issue=1, pageStart=2, pageEnd=10, url=null, language=null, rfNumber=[13], rfOrder=22, authorNames=Dai T, journalName=Chinese Journal of Health Policy, refType=null, unstructuredReference=Dai T. Analysis of the key elements on people-centered integrated healthcare system[J]. Chinese Journal of Health Policy, 2022, 15(1): 2-10.(In Chinese), articleTitle=Analysis of the key elements on people-centered integrated healthcare system, refAbstract=null), Reference(id=1322590111750009812, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, doi=null, pmid=null, pmcid=null, year=2021, volume=14, issue=5, pageStart=8, pageEnd=14, url=null, language=null, rfNumber=[14], rfOrder=23, authorNames=许光建, 乔羽堃, journalName=中国卫生政策研究, refType=null, unstructuredReference=许光建，乔羽堃. 我国医疗服务价格调整与医保支付方式改革的联动机制研究[J]. 中国卫生政策研究，2021，14（5）：8-14., articleTitle=我国医疗服务价格调整与医保支付方式改革的联动机制研究, refAbstract=null), Reference(id=1322590111829701589, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, doi=null, pmid=null, pmcid=null, year=2021, volume=14, issue=5, pageStart=8, pageEnd=14, url=null, language=null, rfNumber=[14], rfOrder=24, authorNames=Xu GJ, Qiao YK, journalName=Chinese Journal of Health Policy, refType=null, unstructuredReference=Xu GJ, Qiao YK. Research on the linkage mechanism between the adjustment of medical service price and the reform of medical insurance payment mode in China[J]. Chinese Journal of Health Policy, 2021, 14(5): 8-14.(In Chinese), articleTitle=Research on the linkage mechanism between the adjustment of medical service price and the reform of medical insurance payment mode in China, refAbstract=null), Reference(id=1322590111896810454, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, doi=null, pmid=null, pmcid=null, year=2024, volume=43, issue=6, pageStart=1, pageEnd=4,17, url=null, language=null, rfNumber=[15], rfOrder=25, authorNames=杜奕欣, 周大创, 王文娟, journalName=中国卫生经济, refType=null, unstructuredReference=杜奕欣，周大创，王文娟，等. 基于价值定价的服务激励模型初探:以基层整合型健康服务为例[J]. 中国卫生经济，2024，43（6）：1-4,17., articleTitle=基于价值定价的服务激励模型初探:以基层整合型健康服务为例, refAbstract=null), Reference(id=1322590111959725015, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, doi=null, pmid=null, pmcid=null, year=2024, volume=43, issue=6, pageStart=1, pageEnd=4, 17, url=null, language=null, rfNumber=[15], rfOrder=26, authorNames=Du YX, Zhou DC, Wang WJ, journalName=Chinese Health Economics, refType=null, unstructuredReference=Du YX, Zhou DC, Wang WJ, et al. Exploring a Value-Based pricing service incentive model:taking primary integrated primary healthcare services as an example[J]. Chinese Health Economics, 2024, 43(6): 1-4, 17.(In Chinese), articleTitle=Exploring a Value-Based pricing service incentive model:taking primary integrated primary healthcare services as an example, refAbstract=null), Reference(id=1322590112039416792, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, doi=null, pmid=null, pmcid=null, year=2024, volume=43, issue=5, pageStart=63, pageEnd=67, url=null, language=null, rfNumber=[16], rfOrder=27, authorNames=居灿灿, 徐伟, 刘萍, journalName=中国卫生经济, refType=null, unstructuredReference=居灿灿，徐伟，刘萍，等. 医疗服务调价总量如何分配:医疗服务价格改革试点城市经验探索[J]. 中国卫生经济，2024，43（5）：63-67., articleTitle=医疗服务调价总量如何分配:医疗服务价格改革试点城市经验探索, refAbstract=null), Reference(id=1322590112110719961, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, doi=null, pmid=null, pmcid=null, year=2024, volume=43, issue=5, pageStart=63, pageEnd=67, url=null, language=null, rfNumber=[16], rfOrder=28, authorNames=Ju CC, Xu W, Liu P, journalName=Chinese Health Economics, refType=null, unstructuredReference=Ju CC, Xu W, Liu P, et al. How to allocate the total price adjustments for medical services: exploring the experience of the pilot cities for medical service price reform[J]. Chinese Health Economics, 2024, 43(5): 63-67.(In Chinese), articleTitle=How to allocate the total price adjustments for medical services: exploring the experience of the pilot cities for medical service price reform, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322590101708845978, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, xref=1., ext=[AuthorCompanyExt(id=1322590101725623195, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, companyId=1322590101708845978, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Shunyi District Hospital, Beijing 101300, China), AuthorCompanyExt(id=1322590101939532700, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, companyId=1322590101708845978, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.北京市顺义区医院，北京 101300)]), AuthorCompany(id=1322590102832919453, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, xref=2., ext=[AuthorCompanyExt(id=1322590102841308062, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, companyId=1322590102832919453, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.北京市顺义区卫生和健康委员会，北京 101300)])], figs=[ArticleFig(id=1322590104598721453, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=EN, label=Figure 1, caption=Distribution map of the medical service income, figureFileSmall=kzoMznUBA5CKKgyDRMMgVA==, figureFileBig=qRBjNbFmJZTobyKvZWemRA==, tableContent=null), ArticleFig(id=1322590104682607534, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=CN, label=图1, caption=北京市某区对数医疗服务收入分布图

注：A一级医院；B二级医院；C三级医院。

, figureFileSmall=kzoMznUBA5CKKgyDRMMgVA==, figureFileBig=qRBjNbFmJZTobyKvZWemRA==, tableContent=null), ArticleFig(id=1322590105018151855, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=EN, label=Figure 2, caption=Distribution map of the proportion of medical service income, figureFileSmall=KkwUSiO1BUl+a6Xx/pfKHw==, figureFileBig=U07FNB3DCMiNpNJa1dRNdg==, tableContent=null), ArticleFig(id=1322590105089455024, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=CN, label=图2, caption=北京市某区医疗服务收入占比分布图

注：A一级医院；B二级医院；C三级医院。

, figureFileSmall=KkwUSiO1BUl+a6Xx/pfKHw==, figureFileBig=U07FNB3DCMiNpNJa1dRNdg==, tableContent=null), ArticleFig(id=1322590105374667697, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=EN, label=Figure 3, caption=Distribution map of the average medical service income per outpatient, figureFileSmall=S0v23Lb3ML9KiYHcWlnilQ==, figureFileBig=v7u2lmT0BYBWPnxjZ0I9jA==, tableContent=null), ArticleFig(id=1322590105445970866, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=CN, label=图3, caption=北京市某区门急诊次均医疗服务收入分布图

注：A一级医院；B二级医院；C三级医院。

, figureFileSmall=S0v23Lb3ML9KiYHcWlnilQ==, figureFileBig=v7u2lmT0BYBWPnxjZ0I9jA==, tableContent=null), ArticleFig(id=1322590107081749427, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=EN, label=Table 1, caption=

Changes in medical institutions’ revenue in a certain district of Beijing after the two reforms（）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目级别改革前
2016年1月—2017年3月（T0）		医药分开改革
2017年4月—2019年5月(T1)		医耗联动改革
2019年6月—2024年4月(T2)		平均差值(T1-T0)平均差值(T2-T1)
总医疗收入（万元）一级医院114.41±79.69167.63±113.35199.21±337.3553.2231.58
二级医院1 913.83±815.662 366.04±926.453 482.72±1 924.78452.211 116.68
三级医院5 192.72±4 413.455 831.83±4 946.586 367.96±5 066.17639.11536.13
医疗服务收入（万元）一级医院8.18±10.0823.01±24.9921.01±67.4114.83-2
二级医院259.26±123.50525.99±188.941 113.68±858.54266.73587.69
三级医院593.77±482.721 230.04±1 014.791 576.60±1 260.88636.27346.56
医疗服务收入占比（%）一级医院6.96±8.1914.10±8.6911.08±7.467.14-3.02
二级医院13.23±11.6722.54±14.6328.47±7.359.315.93
三级医院11.65±10.7722.98±3.0123.90±6.1111.330.92
门急诊次均医疗服务收入(元)一级医院16.03±18.3137.34± 27.1432.52± 108.8421.31-4.82
二级医院45.77±3.8380.41±9.26159.44±66.0434.6479.03
三级医院66.50±6.29171.64±31.48193.90±93.56105.1422.26
), ArticleFig(id=1322590107178218420, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=CN, label=表1, caption=

两项改革期间北京市某区医疗机构收入变化情况（）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目级别改革前
2016年1月—2017年3月（T0）		医药分开改革
2017年4月—2019年5月(T1)		医耗联动改革
2019年6月—2024年4月(T2)		平均差值(T1-T0)平均差值(T2-T1)
总医疗收入（万元）一级医院114.41±79.69167.63±113.35199.21±337.3553.2231.58
二级医院1 913.83±815.662 366.04±926.453 482.72±1 924.78452.211 116.68
三级医院5 192.72±4 413.455 831.83±4 946.586 367.96±5 066.17639.11536.13
医疗服务收入（万元）一级医院8.18±10.0823.01±24.9921.01±67.4114.83-2
二级医院259.26±123.50525.99±188.941 113.68±858.54266.73587.69
三级医院593.77±482.721 230.04±1 014.791 576.60±1 260.88636.27346.56
医疗服务收入占比（%）一级医院6.96±8.1914.10±8.6911.08±7.467.14-3.02
二级医院13.23±11.6722.54±14.6328.47±7.359.315.93
三级医院11.65±10.7722.98±3.0123.90±6.1111.330.92
门急诊次均医疗服务收入(元)一级医院16.03±18.3137.34± 27.1432.52± 108.8421.31-4.82
二级医院45.77±3.8380.41±9.26159.44±66.0434.6479.03
三级医院66.50±6.29171.64±31.48193.90±93.56105.1422.26
), ArticleFig(id=1322590107417293749, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=EN, label=Table 2, caption=

The RDiT results (log of medical service income)

, figureFileSmall=null, figureFileBig=null, tableContent=
改革级别一级医院二级医院三级医院
阶数123123123
医药分开回归系数0.9640.8820.6510.5550.5110.3860.6460.6540.576
P值0.0010.0770.1490.1550.4430.6520.5380.7060.812
带宽10.6514.918.5814.1516.7518.9114.2217.3119.4
样本数5046968165864688799105
医耗联动回归系数-0.108-0.187-0.3540.3790.4110.3560.1800.1910.144
P值0.4010.2870.1510.2580.3500.5260.7780.8620.889
带宽7.8310.9413.2212.6317.9821.2914.2921.0123.22
样本数36050464850708687129141
), ArticleFig(id=1322590107509568438, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=CN, label=表2, caption=

时间断点回归结果（对数医疗服务收入）

, figureFileSmall=null, figureFileBig=null, tableContent=
改革级别一级医院二级医院三级医院
阶数123123123
医药分开回归系数0.9640.8820.6510.5550.5110.3860.6460.6540.576
P值0.0010.0770.1490.1550.4430.6520.5380.7060.812
带宽10.6514.918.5814.1516.7518.9114.2217.3119.4
样本数5046968165864688799105
医耗联动回归系数-0.108-0.187-0.3540.3790.4110.3560.1800.1910.144
P值0.4010.2870.1510.2580.3500.5260.7780.8620.889
带宽7.8310.9413.2212.6317.9821.2914.2921.0123.22
样本数36050464850708687129141
), ArticleFig(id=1322590107647980471, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=EN, label=Table 3, caption=

The RDiT results (the proportion of medical service income)

, figureFileSmall=null, figureFileBig=null, tableContent=
改革级别一级医院二级医院三级医院
阶数123123123
医药分开回归系数0.0670.0570.0220.0950.0900.0770.0910.0850.079
P值0.1690.6480.831000000
带宽11.2116.8420.088.1712.6915.468.3212.2615.45
样本数552768864345062517593
医耗联动回归系数-0.009-0.016-0.0170.0650.0650.0640.0120.006-0.000 1
P值0.2560.1910.2240.0060.0250.0500.7490.9580.920
带宽6.9111.6420.7211.1414.3218.728.5912.2515.01
样本数3125520.984465874517593
), ArticleFig(id=1322590107731866552, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=CN, label=表3, caption=

北京市某区医药分开与医耗联动改革的时间断点回归结果（医疗服务收入占比）

, figureFileSmall=null, figureFileBig=null, tableContent=
改革级别一级医院二级医院三级医院
阶数123123123
医药分开回归系数0.0670.0570.0220.0950.0900.0770.0910.0850.079
P值0.1690.6480.831000000
带宽11.2116.8420.088.1712.6915.468.3212.2615.45
样本数552768864345062517593
医耗联动回归系数-0.009-0.016-0.0170.0650.0650.0640.0120.006-0.000 1
P值0.2560.1910.2240.0060.0250.0500.7490.9580.920
带宽6.9111.6420.7211.1414.3218.728.5912.2515.01
样本数3125520.984465874517593
), ArticleFig(id=1322590107832529849, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=EN, label=Table 4, caption=

The RDiT results (medical service income per outpatient)

, figureFileSmall=null, figureFileBig=null, tableContent=
改革级别一级医院二级医院三级医院
阶数123123123
医药分开回归系数18.58016.51311.28123.00219.89619.2949.78345.87343.697
P值0.0700.4090.5750.0120.0540.041000
带宽11.4715.6419.976.519.6116.597.5010.5714.41
样本数552744840263864456387
医耗联动回归系数-2.865-1.266-6.87817.68819.75819.7581.5720.7710.771
P值0.6150.8350.1530.0160.0150.0150.9720.8850.885
带宽7.5115.6316.1612.6914.6914.697.98139913.19
样本数360744792505858458181
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北京市某区医药分开与医耗联动改革的时间断点回归结果（门急诊次均医疗服务收入）

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改革级别一级医院二级医院三级医院
阶数123123123
医药分开回归系数18.58016.51311.28123.00219.89619.2949.78345.87343.697
P值0.0700.4090.5750.0120.0540.041000
带宽11.4715.6419.976.519.6116.597.5010.5714.41
样本数552744840263864456387
医耗联动回归系数-2.865-1.266-6.87817.68819.75819.7581.5720.7710.771
P值0.6150.8350.1530.0160.0150.0150.9720.8850.885
带宽7.5115.6316.1612.6914.6914.697.98139913.19
样本数360744792505858458181
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The RDiT results (bandwidth sensitivity test)

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改革指标级别一级医院二级医院三级医院
带宽510152051015205101520
医药分开log医疗回归系数0.6660.9411.036*1.035*0.3530.5040.5570.5560.5570.6210.6430.633
服务收入样本数21645669684018385870275787105
门急诊次回归系数12.85017.97820.58920.497*11.61522.90327.20229.593*69.607*76.130*82.803*87.306*
均医疗服
务收入样本数21645669684018385870275787105
医疗服务回归系数0.0310.0630.0770.0790.077*0.100*0.103*0.102*0.084*0.095*0.103*0.107*
收入占比样本数21645669684018385870275787105
医耗联动log医疗回归系数-0.2020.0080.1670.0620.1510.3520.3590.283-0.1010，1440.1730.094
服务收入样本数21645669693618385878275787117
门急诊次回归系数-2.927-1.548-0.919-6.95638.702*32.073*29.822*36.420*5.1936.0367.2148.275
均医疗服
务收入样本数21645669693618385878275787117
医疗服务回归系数-0.009-0.0070.001-0.0030.0590.066*0.064*0.064*0.0040.0150.0200.017
收入占比样本数21645669693618385878275787117
), ArticleFig(id=1322590108071605180, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590095270589323, language=CN, label=表5, caption=

北京市某区医药分开与医耗联动改革的时间断点回归结果（带宽敏感性测试）

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改革指标级别一级医院二级医院三级医院
带宽510152051015205101520
医药分开log医疗回归系数0.6660.9411.036*1.035*0.3530.5040.5570.5560.5570.6210.6430.633
服务收入样本数21645669684018385870275787105
门急诊次回归系数12.85017.97820.58920.497*11.61522.90327.20229.593*69.607*76.130*82.803*87.306*
均医疗服
务收入样本数21645669684018385870275787105
医疗服务回归系数0.0310.0630.0770.0790.077*0.100*0.103*0.102*0.084*0.095*0.103*0.107*
收入占比样本数21645669684018385870275787105
医耗联动log医疗回归系数-0.2020.0080.1670.0620.1510.3520.3590.283-0.1010，1440.1730.094
服务收入样本数21645669693618385878275787117
门急诊次回归系数-2.927-1.548-0.919-6.95638.702*32.073*29.822*36.420*5.1936.0367.2148.275
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医疗服务回归系数-0.009-0.0070.001-0.0030.0590.066*0.064*0.064*0.0040.0150.0200.017
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医药分开与医耗联动综合改革对北京市某区医疗服务收入及其结构的影响——基于RDiT实证研究
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杨辉 1, 2
现代预防医学 | 卫生政策与管理 2025,52(1): 108-113
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现代预防医学 |卫生政策与管理 2025 , 52 (1) : 108 -113
医药分开与医耗联动综合改革对北京市某区医疗服务收入及其结构的影响——基于RDiT实证研究
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2.北京市顺义区卫生和健康委员会，北京 101300, bio={"content":"

杨辉（1984—），男，硕士，副研究员，研究方向：卫生政策评估

"}, bioImg=null, bioContent=

杨辉（1984—），男，硕士，副研究员，研究方向：卫生政策评估

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杨辉1, 2
作者信息
  • 1.北京市顺义区医院，北京 101300
  • 2.北京市顺义区卫生和健康委员会，北京 101300
通讯作者:
杨辉，E-mail:
作者简介:

杨辉（1984—），男，硕士，副研究员，研究方向：卫生政策评估

The impact of the separation of medicine and pharmacy and the integrated reform of medical expenses on medical service revenue and its structure in a district of Beijing: an empirical study based on RDiT
Hui YANG1, 2
Affiliations
  • Shunyi District Hospital, Beijing 101300, China
出版时间: 2025-01-10 doi: 10.20043/j.cnki.MPM.202406445
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摘要
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目的

分析医药分开和医耗联动综合改革对北京市某区医疗服务收入的影响。

方法

利用2016年1月—2024年4月的监测数据，构建时间断点回归模型进行分析。

结果

医药分开改革实施后，二、三级医院的医疗服务收入占比和门急诊次均医疗服务收入得到显著提升（P<0.05）。医耗联动改革实施后，二级医院门急诊次均医疗服务收入和服务收入占比得到显著提升（P<0.05）。

结论

改革实施后医疗服务收入总量和占比得到显著提升，收入结构进一步优化，技术劳务价值得到更加充分体现。但医疗服务收入占比还比较低，建议完善改革联动机制，强化医疗服务监管，推动医疗资源均衡分布，重点加强基层医疗机构服务能力提升。

医药分开  /  医耗联动  /  时间断点回归  /  医疗服务收入
Objective

To analyze the impact of the separation of medicine and pharmacy and the integrated reform of medical expenses on medical service revenue in a district of Beijing.

Methods

Utilizing monitoring data from January 2016 to April 2024, a time breakpoint regression model was constructed for analysis.

Results

Following the implementation of the separation of medicine and pharmacy reform, the proportion of medical service revenue and the average medical service revenue per visit in secondary and tertiary hospitals significantly increased (P<0.05). After the implementation of the integrated reform of medical expenses, the average medical service revenue per visit and the proportion of service revenue in secondary hospitals also saw significant increases (P<0.05).

Conclusion

After reform, the total amount and proportion of medical service revenue have significantly increased, with further optimization of the revenue structure and a more adequate reflection of the value of technical services. However, the proportion of medical service revenue remains relatively low. It is recommended to enhance the reform linkage mechanism, strengthen the supervision of medical services, promote the balanced distribution of medical resources, and focus on improving the service capacity of primary healthcare institutions.

Separation of medicine and pharmacy  /  Integrated reform of medical expenses  /  Time breakpoint regression  /  Medical service revenue
杨辉. 医药分开与医耗联动综合改革对北京市某区医疗服务收入及其结构的影响——基于RDiT实证研究. 现代预防医学, 2025 , 52 (1) : 108 -113 . DOI: 10.20043/j.cnki.MPM.202406445
Hui YANG. The impact of the separation of medicine and pharmacy and the integrated reform of medical expenses on medical service revenue and its structure in a district of Beijing: an empirical study based on RDiT[J]. Modern Preventive Medicine, 2025 , 52 (1) : 108 -113 . DOI: 10.20043/j.cnki.MPM.202406445
正文
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长期以来，公立医院的收入严重依赖药品和医疗耗材的使用，而体现医务人员技术劳务价值的诊疗、手术等项目的价格偏低，导致“以药补医”和“以耗补医”的乱象，不仅扭曲了医院费用结构，还对医务人员的服务质量产生了一定影响。为加快建立健全公立医院运行新机制，2017年4月，北京市启动了医药分开综合改革，采取了取消药品加成、设立医事服务费、规范医疗服务价格等措施，破除“以药补医”机制。2019年6月，启动了医耗联动综合改革，取消耗材加成，提升中医、手术等医疗服务项目价格，并实施耗材联合采购。这两项改革（简称两项改革）推动医疗机构转向以技术劳务为核心的服务收入结构调整，促进公立医院的良性运行。
持续进行改革效果评估是改革的重点任务之一。研究表明，两项改革在控制费用不合理增长、优化费用结构等方面取得了显著成效[1-4]。然而，相关研究对医疗服务收入的关注较少，且研究方法多采用间断时间序列分析。鉴于此，本文通过构建断点回归模型，分析两项改革对北京市某区医疗服务收入及其结构的影响，为进一步推进医药卫生体制改革提供参考。
1　资料与方法
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1.1　研究对象与资料来源
本文研究对象为北京市某区参加改革医疗机构，其中三级医院3家、二级医院2家、一级医院（社区卫生服务中心）23家。数据来源为北京市卫健委改革监测月报，分析时间范围是2016年1月—2024年4月。为确保数据质量，对原始数据中的异常值予以删除。考虑到收入数据呈偏态分布，对数据进行取对数处理。上述数据经清洗后导入stata17进行分析。
1.2　研究方法
断点回归设计（regression discontinuity design, RDD）是一种准实验计方法，广泛用于评估政策或其他干预措施的效果[5]。在RDD中，当驱动变量达到断点时，处置发生变化。通过比较阈值附近未接受干预的个体与接受干预的个体之间的差异，从而估计处置对结果变量的因果影响[6]。时间断点回归（regression discontinuity in time, RDiT）以时间单位为驱动变量，以个体在不同时点上是否接受政策作为处置变量，通过比较断点前后无限接近断点的样本结果变量期望值之间的差异，推断平均处理效应（average treatment effect, ATE）[7-8]。考虑到本文样本数量较少，通过均方误差（mean-square error, MSE）确定最优窗宽后[9]进行分析，并通过改变阶数和变换带宽等方法检验回归结果的稳健性。模型可以表示为：
yi是结果变量，xi是驱动变量，以实施医药分开政策2017年4月为断点c1（0），医耗联动政策2019年6月为断点c2（26）。xi-c计算与断点的时间间隔，Di为改革启动虚拟变量。(xi-c)Di是驱动变量和虚拟变量的交互函数，δ表示改革在断点处的斜率变化，γ是改革后的斜率变化。K为核函数，h为带宽。根据回归系数的P值确定改革实施前后指标变化是否具有统计学意义（以P<0.05作为差异有统计学意义的指标）。
1.3　评价指标
本研究的结果变量包括医疗服务收入及其占比和门急诊次均医疗服务收入。医疗服务收入被定义为医疗收入中不包含药品、耗材和检查收入，这一指标能够直观地反映医务人员的技术劳务价值。医疗服务收入占比被定义为医疗服务收入与医疗总收入的比值，是衡量收入结构的指标之一。门急诊次均医疗服务收入被定义为门急诊医疗服务收入与门急诊诊疗人次数的比值，可以从个体层面反映医疗服务收入的变化情况。
2　结果
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2.1　医疗机构技术劳务收入与总医疗收入变化情况
表1分析两项改革后医疗收入、医疗服务收入及其占比和门急诊次均医疗服务收入的变化情况。
2.2　两项改革对医疗服务收入影响的RDiT分析
在进行断点回归分析之前，通过绘图初步判定结果变量在断点处的分布情况及变化趋势。图1显示，医药分开改革实施后，对数医疗服务收入在断点处均出现明显提升。图2显示，服务收入占比方面，二级和三级医院在医药分开改革实施当月均出现明显断点，而二级医疗机构在医耗联动改革实施当月也出现了断点。图3显示，二级和三级医院的门急诊次均医疗服务收入在医药分开改革实施当月出现断点，二级医院在医耗联动改革实施当月也出现了断点。综上所述，可以初步判断处理效应存在，但图中展示的仅是变量的分布情况，需通过断点回归进行统计学检验。
在医疗服务收入方面，表2结果可以看出，医药分开综合改革实施后，在最优带宽一次项回归中，三级、二级和一级医院的医疗服务收入分别增长了0.646，0.555和0.964，其中一级医院医疗服务收入变动具有统计学意义（P<0.05）。医耗联动综合改革实施后，三级、二级和一级医院的医疗服务收入分别增长了0.180、0.379和-0.108，改革对医疗服务收入的变化趋势均无显著影响(P>0.05)。
在医疗服务收入占比方面，从表3的回归结果可以看出，医药分开综合改革实施后，在最优带宽回归一次项回归中，三级、二级和一级医院服务收入占比分别增长了6.7%、9.5%和9.1%，其中二级、三级医院的医疗服务收入占比提升具有统计学意义(P<0.05)。医耗联动综合改革实施后，三级、二级和一级医院服务收入占比增长了-0.9%、6.5%和1.2%，二级医院医疗服务收入占比的变化趋势具有统计学意义(P<0.05)。
在门急诊次均医疗服务收入方面，表4结果可以看出，在最优带宽一次项回归中，医药分开改革显著升高了门急诊次均医疗服务收入，其中二级和三级医院分别提升了23.02和49.78元，且具有统计学意义（P<0.05）。医耗联动改革中，二级医院门急诊次均医疗服务收入提升了17.69元，具有统计学意义(P<0.05)。
2.3　断点回归结果的稳健性检验
带宽选择作为影响断点回归模型无偏性和有效性的关键因素[9]，通过在不同带宽下拟合断点回归模型，可以获得不同时间范围内的干预效果。本文以一次项回归结果为基准模型，通过变换带宽的方法进行稳健性检验。如表5所示，不同带宽选择下的分析结果与本文上述分析结果基本一致。在医药分开改革开始的10月内，对数医疗服务收入的效果不显著，而15个月后，一级医院的政策效果开始显现并持续延续。医耗联动改革启动后，二级医院在所有带宽内的效果均显著，而一级和三级医院则不显著。医疗服务收入占比在二级及三级医院的所有带宽下均显著，而医耗联动改革在二级医院在带宽10及以上时均显著。在门急诊次均医疗服务收入变动方面，医药分开改革对二、三级医院在所有带宽下均显著，而医耗联动改革在带宽大于10时，仅对二级医院显著。
3　讨论
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3.1　两项改革对医疗服务收入占比的显著影响
两项改革实施后，显著提升了医疗服务收入总量和占比，优化了收入结构，进一步体现了医务人员技术劳务的价值。相比医疗服务收入总量，医疗服务收入占比作为衡量收入结构的指标，更能反映医务人员技术劳动价值的变化。本文研究结果表明，医药分开改革启动后，医疗服务收入占比在改革当月显著上升，而医耗联动改革启动当月的提升则不明显。医药分开改革取消了挂号费并设立了医事服务费，直接补偿了医疗机构因药品加成取消所带来的收入损失，快速实现了补偿机制的转换与收入结构调整。相较而言，医耗联动改革启动后，主要调整了中医、病理、康复、精神和手术等项目的价格，影响的患者群体较为有限，因此在改革当月对医疗服务收入占比的瞬时影响不明显。然而，随着改革的持续推进，医疗服务收入占比呈现出上升趋势，这与医疗服务价格调整、医保支付方式改革及国家公立医院考核等多种措施的综合作用密切相关。医疗服务价格调整作为提升服务收入的主导性措施，显著影响了医院的经济运行和收入结构，提升了医务人员的技术劳务价值，并提高了服务收入占比[10-11]。DRG支付方式改革则推动了医院的精细化管理，有效减少了过度医疗，促进了医疗机构向内涵质量效益型方向发展[12]。随着医疗服务收入占比被纳入国家公立医院考核和高质量发展评价指标，绩效考核的“指挥棒”作用愈加显著，有力推动了医疗机构提质增效。
3.2　两项改革对不同级别医疗机构的差异性影响
本文研究显示，医药分开改革实施后，一级医院的医疗服务收入，二、三级医院的门急诊次均医疗服务收入和服务收入占比均有不同程度的提升（P<0.05）。然而，在医耗联动改革启动后，一级医院的医疗服务收入总量及占比和门急诊次均医疗服务收入出现了不同程度的下降，而二级医院的医疗服务收入占比和门急诊次均医疗服务收入则呈现显著提升。二、三级医院在提升服务收入占比方面的效果更为显著，主要得益于其在技术水平、资源配置和政策激励方面的优势。一级医院的医疗服务收入增长主要受医事服务费上涨的推动，然而其服务收入占比与二、三级医院仍存在较大差距。由于设备和人员配置有限，能够提供的高技术含量医疗服务项目较少，因此服务价格调整对其影响较小。加之日常接诊的多为常见病和多发病，病种结构单一，药品收入仍是一级医院的主要收入来源，导致服务收入占比的改善空间有限。相比之下，二、三级医院能够执行复杂的手术和高技术含量的医疗操作。研究表明，随着医院级别的提高，手术费用收入占比显著增加，改革后此类项目的提供量也显著上升[13]。因此，二、三级医院在技术劳务收入的提升上更具优势，而一级医院在技术劳务收入持续增长方面面临更大挑战。
3.3　通过多种手段进一步优化收入结构
尽管两项改革实施后，医疗服务收入及其占比有所上升，但仍未达到“十四五”期末医疗服务收入占比达到40%的目标。医疗服务收入占比与价格结构密切相关，建议进一步理顺医疗服务价格之间的比价关系，加快建立以人为中心、以价值为导向的价格调整机制[14]。应当实现医疗技术价值与医保科学管理的协同[15-16]，加快形成“医保、医疗、医药”协同发展的治理体系[14]。然而，提高医疗服务价格可能会导致医生利用信息优势诱导患者消费更多的服务，因此需要加强监管，通过建立系统化的监督和反馈机制，确保改革举措的有效执行。同时，一级医院医疗服务收入占比仍偏低，应加大对基层医疗的投入，通过医联体和对口支援等方式，培养和留住基层医疗人才[15]，提升基层医疗服务水平。医院服务能力是影响医疗服务收入结构的关键因素，因此需要推动价值医疗，促进从服务量驱动模式向价值驱动模式的转变。通过技术创新和管理优化，提高医院的服务效率与质量，提升患者的就医体验。此外，完善人员薪酬分配制度，鼓励将扣除成本后的技术劳务收入用于人员奖励，以支持医院的高质量发展和改善医务人员的待遇。建立绩效考核与收入分配挂钩的机制，激发医务人员的工作积极性和创新能力。通过优化医院内部管理流程，减少医务人员的非医疗工作负担，使其能够专注于提供高质量的医疗服务。

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doi: 10.20043/j.cnki.MPM.202406445
  • 接收时间：2024-06-24
  • 首发时间：2026-10-29
  • 出版时间：2025-01-10
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  • 收稿日期：2024-06-24
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    1.北京市顺义区医院，北京 101300
    2.北京市顺义区卫生和健康委员会，北京 101300

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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