本文基于北京新医改前后医事服务费和医疗服务价格对公立医院的补偿情况，卫生资源配置、医疗服务利用和费用的变化情况，以F区某二级医院为研究目标，采用前后对比的方法比较门诊费用及住院典型付费方式、主要疾病病种的费用结构变动情况，定量资料采用描述性分析、构成比、卡方检验、非参数检验等统计学方法进行统计描述，定性数据采用深入访谈的办法了解各费用变动的原因及可能出现的结果。深入探索二级公立医院改革的成效和存在的问题，并提出相应的对策和建议，为该院继续贯彻新医改政策，平衡医疗费用结构，提高管理水平提供参考，为相关部门制定医改政策提供依据。新医改前后，在政府财政补偿不足的情况下，该院资产总体处于亏损状态，医改后减少了6.86%。门诊费用方面，医改后，门诊总费用下降了6.57%，次均费用下降了13.04%，其中药品费减少了4.72%；住院费用方面，住院总费用增加了8.12%，住院患者次均费用增加了8.31%，药品费占比下降了9.74%，住院患者卫生材料费增加了3.33%，药品费和卫生材料费用构成比与北京医改目标相比仍相对偏高。从主要的付费方式来看，职工医保住院患者医改后药占比最高为47.76%，从次均费用的增幅来看商业保险付费方式增幅最大为32.35%,从各付费方式的费用构成结构来看，职工医保药占比下降幅度最大为16.43%；从该院主要疾病病种来看，医改后不稳定性心绞痛患者占比最高为11.15%，从次均费用的增幅来看，不稳定性心绞痛患者次均费用增幅最大为7.81%，从病种住院费用结构来看后循环缺血药占比降幅最大为13.55%。各病种费用构成医改前后呈现出不同差异性。新医改推行后，公立医院的卫生资源配置仍有待完善，患者总体费用虽得到一定程度的控制，但是次均费用、药品费和卫生材料费用总体呈现上升趋势。医院总体财政补偿不足，医事服务费、体现医护人员劳动价值技术含量的收入构成比虽有增加，但是仍不能实现收入平移。医院应该在争取政府财政补助的同时加强对手术等相关科室的培育力度，改变过分依靠内科开药的经营模式，适当缩小医院规模，进一步降低医院管理成本。在支付方式上，相关部门应该在完善总额预付制的同时，加快按病种付费的实施，正向激励医院寻求更优治疗方案，在不增加患者支出的情况下，增加医院的收益。

Based on the compensation of medical service fees and medical service prices for public hospitals before and after the Beijing New Medical Reform, changes in the allocation of health resources, utilization of medical services, and costs. A secondary hospital in District F is used as the research objective, and the comparison method is used to compare Outpatient expenses and typical payment methods for hospitalization, changes in the cost structure of major diseases and diseases, quantitative data are described by statistical methods such as descriptive analysis, composition ratio, chi-square test, and non-parametric tests, and qualitative data are interviewed in depth Understand the reasons for the changes in fees and the possible results. In-depth exploration of the effectiveness and problems of the reform of second-level public hospitals, and put forward corresponding countermeasures and recommendations for the hospital to continue to implement the new medical reform policy, balance the medical cost structure, improve management level, provide reference for relevant departments to formulate medical reform policies.The hospital‘s health resource allocation and the structure of income and expenditure have changed before and after the new medical reform. Due to the insufficient financial compensation from the government, the total assets of the hospital were in a state of negative growth, which was reduced by 6.86% after the reform; Total cost of outpatient has fallen by 6.57% and the average cost per time fell by 13.04% after the reform, among which the medicine cost decreased by 4.72%;hospitalization cost increased by 8.12% and the average cost per time increased by 8.31%, among which the medicine cost dropped by 9.74%, and the raw materials cost of inpatients increased by 3.33%. Compared with the aim of medical reform, the proportion of medicine cost and raw materials cost were relatively higher. In terms of the principal payment method, the proportion of medicine cost in total cost of hospitalizedpatients withhealth insuranceaccounted for 47.76%, is the highest after from time cost performance of the commercial insurance payment increased by 32.35% in view of the average cost per time; in terms of the structure of the payment composition, the proportion of medicine cost in total cost of different payment method all slightly declined, among which the decline of hospitalizedpatients withhealth insurance was the largest, reaching 16.43%; From the perspective of the main diseases type of the hospital, the highest proportion was patients with unstable angina after the medical reform, which reached 11.15%; and by the average cost per time, the growth of patients with unstable angina was the largest, which reached 7.81%; from the perspective of the hospitalization cost structure of different diseases type, the cost of posteriorcirculationischemiamedicine decreased largest, reaching 13.55%. Cost composition’s difference exist before and after the reform.By implementing of the new medical reform, the health resources’ allocation in public hospitals needs to be improved, and the total cost of patients is controlled to a certain extent, but the average cost per time, medicine cost and raw material cost are on the rise. Hospital’s overall financial compensation is insufficient, although the composition proportion of income, which reflects the labor vale and technical content of medical personnel, had increased modestly, but still lower than expectation. The hospital needs to enhance the training of surgery and other relevant departments, transform the management mode of relying heavily on medical prescriptions, reduce the scale of hospital appropriately and further decrease the cost of hospital management, while seeking financial compensation. In terms of payment method, relevant departments should accelerate the implementation of payment by disease type while improving the total prepayment system, encourage hospitals to seek better treatment plans and increase the profits of hospitals without increasing the expenditure of patients.