总额预付改革对住院患者费用控制效果的研究  

Research on the Effects of Global Budget Reform on the Cost Control of Hospitalization Patients

作　　者：郎婧婧 周海龙 于雪梅[2] 江芹 LANG Jing-jing ZHOU Hai-long YU Xue-mei et al(China National Health and Development Research Center, Beijing, 100191, China)

机构地区：[1]国家卫生计生委卫生发展研究中心,北京100191 [2]哈尔滨医科大学,哈尔滨150086

出　　处：《中国卫生经济》2017年第2期20-22,共3页Chinese Health Economics

摘　　要：目的:通过分析案例医院总额预付改革的实施效果,为完善总额预付实施方案提供合理性建议。方法:通过定性访谈、描述性统计分析、中断时间序列分析比较总额预付改革实施前后平均住院日、次均费用、出院人次等指标的变化。结果:改革后的出院总费用和出院人次增长幅度放缓,次均费用下降明显,平均住院日不降反升。结论:支付方式改革需要重视不同医保类型的协调统一;总额预付改革需要配合按床日、按病种、或者按DRG等其他支付方式改革;总额预付的实施需要配套制定全面的考核和监管方案。Objective： To analyze the implementation effect of global budget payment in the pilot hospitals and provide reasonable advices to improve the implementation planning of tile global budget payment reform. Methods： By using the qualitative interviews, descriptive statistics and method of interrupted time series analysis, it compared the changes of the indicators ineluding average length of stay, average hospitalization expense and number of discharged patients before and after the reform. Results： After the re- form, the growth range of the total hospitalization expenses and the number of discharged patients decreased, the average hospitaliza- tion expense has been remarkably decreased but the average length of hospitalization was increased. Conclusion： Emphasis should be given to the harmonization of payment reform measures towards difterent health insurances. The global budget reform should be in line with other payment methods such as per diem, case-based payment and diagnosis related groups（DRGs）; comprehensive assessment and regulatory, program needed to be taken to support the implementation of global budget reform.

关 键 词：住院患者 医疗费用 支付方式 总额预付 中断时间序列分析 

分 类 号：R197.32[医药卫生—卫生事业管理]