目的 分析 2012 年~ 2017 年我院住院医疗费用结构变动的趋势与特征，为我院找到影响住院费用结构变动的主 要费用构成项目，进而优化医疗费用结构提供数据支撑。方法 采用结构变动度指标，分析我院 2012 年~ 2017 年住院医疗费 用构成变动的情况。结果 2012 年~ 2017 年，我院住院费用结构中药品费用所占比例均最高，但药占比逐年下降，连续呈负 向变动;住院费用结构变动贡献率最大的是药品费用，其次是治疗费、材料费、化验费、护理费、检查费;材料费 2015 年~ 2017 年呈正向变动，而体现医务人员技术劳务价值的护理费、诊察费与之相反，2015 年~ 2017 年呈负向变动。结论 取消药品加 成是推动控制药占比的重要因素，医药费用的改革需要进一步思考与探索;应提高医务人员技术劳动价值的服务价格，降低 部分大型设备检查、治疗价格，以进一步优化医疗费用结构。

Objective To analyze the trends and characteristics of hospitalization expense structure (HES) in our hospital from 2012 to 2017 to identify the main items affecting the HES so as to provide data support to optimize the medical expense structure. Methods We used the structural variation index to analyze changes in the HES between 2012 and 2017 in our hospital. Results During the period from 2012 to 2017, drug cost accounted for the largest proportion in HES, however, it declined gradually year by year, exhibiting a negative change. Drug cost was the biggest contributor to the changes in HES, followed by expenses on treatment, material, laboratory test, nursing care, and examination. Material expenses displayed positive changes, while changes were negative in expenses on nursing care and diagnosis, which reflect the technical service value of medical staff. Conclusion Cancellation of drug price addition is important for controlling the proportion of drug cost, and the structure of medical and pharmaceutical expenses should be further reformed. The service fee of medical staff should be raised and the price of examinations and treatment by large equipment should be lowered so as to further optimize the medical expense structure.