上海市某大型三甲综合性医院医保总额预付制实施效果  

The Management Effects of Global Budget in a Tertiary Hospital

作　　者：杨玉婷[1] 王筱慧[2] 姚文华[3] 项耀钧[4] 

机构地区：[1]上海交通大学医学院附属新华医院医务部,上海200092 [2]第二军医大学长海医院医教部质量管理科,上海200433 [3]第二军医大学长海医院医教部教务科,上海200433 [4]第二军医大学长海医院,上海200433

出　　处：《解放军医院管理杂志》2015年第6期562-565,共4页Hospital Administration Journal of Chinese People's Liberation Army

摘　　要：目的通过对上海市某大型三甲综合医院总额预付制实施前后医疗服务效率、质量、费用相关指标总体变化情况进行分析,探讨医保总额预付制的实施对该院服务效率、质量与费用的影响。方法利用SPSS 21.0对该院总额预付制实施前后医保患者和自费患者医疗服务效率、质量、费用相关指标总体变化趋势进行描述性统计分析。结果总额预付制实施后,该院门诊人次、急诊人次、出院人次和手术例次分别增长25.6%、48.5%、18.7%和21.2%。平均住院日下降了1.2天;医保患者CD型率降低了12.2%,自费患者降低了7.6%;医保患者大(特大)手术率每年均低于自费患者9个百分点左右;医保患者医疗总费用同比增幅从2010年12.3%下降至2012年8.9%。结论总额预付制实施后,该院医疗工作效率不断提高;医保患者医疗服务质量有待提高;医保医疗费用控制较好。Objective The indicators of service quality, efficiency, and expenditure were compared before and after the implementation of the global budget in a tertiary comprehensive hospital in Shanghai, the influence of the Global Budget was discussed. Methods With the SPSS 21.0, The changes of these indicators were descriptively analyzed respectively. Results After the implementation of the global budget, the number of outpatients and emergency cases, patients discharged, and inpatients receiving operations increased 25.6% ,48.5% ,18.7% and 21.2% respectively. The CD type proportion of patients insured was reduced by 12.2% ; self - pay patients were reduced by 7.6% , as well. The proportion of major （or critical） operations for patients insured was lower than that of self - pay patients about 9% annually. Year increase of total medical expenditure of patients insured decreased from 12.3% in 2010 to 8.9% in 2012. Conclusion After the implementation of global budget, efficiency of medical services have been steadily increasing, medical service quality needs to be improved for insured patients, and medical expense is controlled well.

关 键 词：总额预付制 医保患者 自费患者 医疗指标 

分 类 号：R197.32[医药卫生—卫生事业管理]