新疆医科大学学报

目的 评估新疆地区“药品零差率”政策对心脑血管疾病患者住院费用结构及次均费用的影响，为完善公立医院补偿机制与控费政策提供依据。方法 基于新疆某三甲综合公立医院2016年1月-2023年12月心脑血管疾病患者住院费用数据，本研究聚焦次均住院费用、次均西药费用及费用构成等核心指标，采用间断时间序列分析(Interrupted time series analysis, ITSA)量化了政策带来的费用水平与趋势的即时与长期变化，并结合结构变动度模型揭示了各分项费用的结构变动贡献率。结果 与政策实施前比较，实施后次均住院费用短期内显著下降(β₂=-12 754.66,P<0.05),长期呈缓慢回升趋势(β_1+β₃=107.40,P<0.05);西药费用占比下降，次均西药费用控制未达显著(P≥0.05)。医院通过增加检查费、化验费等医疗服务性收入(累计贡献率43.87%)弥补药品收入损失，存在将成本从药品转向检查、化验等医疗服务项目的风险。结论 “药品零差率”政策短期内降低住院费用，但需深化医疗、医保、医药领域的协同改革，强化疾病诊断相关分组(Diagnosis related groups, DRG)付费、耗材集采等协同措施，遏制隐性成本转移，巩固政策成效。

Objective To evaluate the impact of the "zero markup drug" policy in the Xinjiang region on the structure of hospitalization costs and average costs per patient for cardiovascular and cerebrovascular disease patients, to providinge a basis for improving the compensation mechanism and cost control policies for public hospitals. Methods Based on inpatient cost data for cardiovascular and cerebrovascular disease patients at a tertiary-level public general hospital in Xinjiang from January 2016 to December 2023, this study focusesd on key indicators such as average per-admission costs, average per-admission pharmaceutical costs, and cost composition. It emploiedys interrupted time series analysis(ITSA) to quantify the immediate and long-term changes in cost levels and trends resulting from the policy, and combinesd a structural change model to reveal the contribution rates of structural changes in each cost component. Results Compared with the period before policy implementation, the average per-admission hospitalization costs decreased significantly in the short term(β₂=-12 754.66, P<0.05) and showed a gradual upward trend in the long term(β_1+β₃=107.40, P<0.05). The proportion of Western medicine costs was decreased, but the average per-visit Western medicine costs did not reach a significant level of control(P≥0.05). Hospitals compensated for the loss of pharmaceutical revenue by increasing medical service-related income such as examination fees and laboratory fees(cumulative contribution rate of 43.87%), posing a risk of shifting costs from pharmaceuticals to medical service projects such as examinations and laboratory tests. Conclusion The "zero markup drug" policy reduces hospitalization costs in the short term, but requires deepening coordinated reforms across healthcare, medical insurance, and pharmaceutical sectors. Strengthening complementary measures such as Diagnosis Related Groups(DRG) payment systems and centralized procurement of medical consumables isis essential to curb hidden cost shifting and consolidate policy outcomes.