目的 了解天津市北辰医院取消药品加成政策及“4＋7”集中采购对患者门诊次均费用的影响。方法 运用结构变动度分析和灰色关联分析，2014—2019年下半年天津市北辰医院患者门诊各项费用结构变动和关联程度。结果 2014—2019年，2019年门诊次均费用增幅0.57%，较2018年增幅明显下降。中成药费、化验检查费、化学药费、体检费构成比变化对患者门诊费用变动度的贡献率较高，累计贡献率达79.85%，除中药饮片费用外其他药品费用均成负性变动。门诊次均费用中，治疗费、化验检查费、中药饮片药费的关联度较大，中成药费、护理费、抗菌药费的关联度小。结论 政策实施发挥药师价值，现政策初现成效，患者药品费用下降，治疗费及化验检查费占比有增加趋势，患者次均费用增幅得到控制，切实降低患者就医负担。

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.

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天津市北辰区科技发展计划项目（2018-SHGY-08）