“按人头支付”改革对参合农民住院就医行为的影响分析  

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

作　　者：崔欣 荆丽梅 孙晓明 娄继权 许靖 黄豪 

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

出　　处：《中国卫生经济》2014年第3期18-20,共3页Chinese Health Economics

基　　金：国家自然科学基金青年项目(71003024);上海市卫生局局级科研项目(20124391);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)

摘　　要：目的:分析新型农村合作医疗实施"按人头支付"改革对参合农民就医行为的影响。方法:收集浦东新区35万参合农民改革前、后住院就医的医院级别、住院费用和补偿金额等数据,并进行统计分析。结果:新型农村合作医疗实施"按人头支付"改革后,住院人群并没有明显的向县级及以下医疗机构下沉的趋势。结论:需要加强针对二、三级医疗机构采取配套的控费措施,同时规范转诊相关标准和流程,以避免需求抑制现象出现。Objective： The aim of this study is to analyze the influence of the inpalient 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 51,000 inpatient records about treatment cost, the amount of compensation and other data from 2011 to 2012. Results： There is no obvious significant effect of guiding more inpatients to the rural hospitals under counly level. Conclusion： It is necessary to launch the cost control measures against the rural hospitals above county level, and standardizing referral standards and processes to avoid demand restraining.

关 键 词：新型农村合作医疗 支付方式改革 按人头支付 住院就医行为 

分 类 号：R197.1[医药卫生—卫生事业管理]