“按人头支付”改革对参合农民门诊就医行为的影响分析  

Influence Analysis of Capitation Reform about the Outpatient Behavior of Participating Farmers

作　　者：荆丽梅 浦良发 崔欣 孙晓明 张群芳 庄悦红 

机构地区：[1]浦东卫生发展研究院,上海200129 [2]浦东新区卫生局,上海200125 [3]浦东新区新型农村合作医疗管理办公室,上海201300

出　　处：《中国卫生经济》2014年第3期16-18,共3页Chinese Health Economics

基　　金：上海市浦东新区卫生系统优秀青年医学人才培养(PWRq2013-21);上海市浦东新区卫生局卫生科技项目(PW2012A-55;PW2012A-57);上海市卫生局局级科研项目(20124391);国家自然科学基金青年项目(71003024)

摘　　要：目的:分析新型农村合作医疗实施"按人头支付"改革对参合农民门诊就医行为的影响。方法:收集试点地区35万参合农民改革实施前、后参合农民门诊就诊的医院级别、门诊费用、补偿金额等就诊数据,并进行统计分析。结果 :支付方式改革对引导门诊人群首诊下沉、逐级转诊已显现出效果,这同时也有利于基金的收支平衡。结论:对于社区卫生服务机构门诊转诊的规范和数量控制的合理性有待进一步探讨。Objective： The aim of this study is to analyze the influence of the outpatient behavior of participating farmers, after the implementation of this reform. Methods： This study collected the NRCMS operational data before and after the implementation of capitation reform. The data included 11.6 million outpatient records about treatment cost, the amount of compensation and other data from 2011 to 2012. Results： The capitation reform can guide the outpatients to go to community health service centers progressively, and the NRCMS fnnd was more secure. Conclusion： There is still research space about how to regulate the patient referral of community agencies more rational.

关 键 词：新型农村合作医疗 支付方式改革 按人头支付 门诊就医行为 

分 类 号：R197.1[医药卫生—卫生事业管理]