上海医保总额预付制对医院服务效率和费用的影响研究  

Study of the impacts of global budget on service efficiency and costs of hospital services in Shanghai

作　　者：杨玉婷[1] 赵蓉 项耀钧[3] 

机构地区：[1]上海交通大学医学院附属新华医院医务部,200092 [2]上海申康医院发展中心 [3]第二军医大学长海医院

出　　处：《中华医院管理杂志》2015年第4期271-274,共4页Chinese Journal of Hospital Administration

摘　　要：目的：通过对上海市三级医院总额预付制实施前后医疗业务量、床位效率、医疗费用及医保相关指标变化进行分析，探讨上海市现行的医保支付制度的现状和问题，评价总额预付制实施对医疗服务数量、效率和费用的作用和影响。方法利用 SPSS 21.0对上海市三级医院医疗业务量、医疗服务效率、医疗费用相关指标在总额预付制实施前后的变化趋势进行描述性统计分析。结果实施总额预付制后，上海市三级医院门急诊人次和出院人数同比增幅均下降约4.0%；2012年较2008年平均住院日共减少4.0天；医疗总费用同比增幅从总额预付制前（21.7%）下降至2012年12.6%；2010年后，医保门急诊人次和出院人次同比不断增加；医保总费用占总费用的比例均低于39.0%，且逐年降低；医保预算核定总量累计完成率每年均高于100.0%，每年均超支；医保药品核定总量累计完成率每年均低于100.0%。结论实施总额预付制后，医疗业务量不断上升，医疗服务效率不断提高，医疗费用控制效果显著，医保患者医疗服务质量有待提高，医保预算总额费用有待进一步控制。Objective To analyze such indices as quantity of care,bed turnover,medical costs and medical insurance in Shanghai′s tertiary hospitals,before and after the implementation of the global budget for a study of the present medical insurance payment in Shanghai.Methods With SPSS 21.0,this thesis conducted a descriptive statistic analysis on changes of such indices as service volume,and efficiency in medical services,medical costs,before and after the implementation of the global budget.Results After the implementation,the year-on-year growth of the number of outpatients and emergency visits,and patients discharged decreased about 4.0%in such hospitals.From 2008 to 2012,the average days of stay dropped by 4.0 days in total.Before the implementation,the growth rate of total costs of medical services was 21.7%,which was only 12.6%in 2012.For those patients under coverage,the number of outpatients and emergency visits,and inpatients discharged kept increasing since 2010.The ratio of total medical insurance cost in the total medical costs fell below 39.0%,dropping year on year.The accumulated completion rate of medical insurance is over 100.0%each year,with overspending each year as well,and such total for drugs covered by medical insurance falls below 100.0%each year.Conclusion The global budget helps push up volume and efficiency of medical services,and helps control medical expense significantly.However,quality of care for patients is expected to improve,and so is further control over the total amount of global budget.

关 键 词：医保 总额预付制 医疗效率 医疗费用 

分 类 号：R197.3[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学]