医保总额预算制对医院的影响及应对策略分析  

The Total Budget Impact of Medical Insurance on Hospitals and the Analysis on the Countermeasures

作　　者：马高祥 祁丽萍 方斌 吴志明 余利荣 陈经萍 楼霞媛 李素娟 何瑛 

机构地区：[1]绍兴市中心医院,浙江省绍兴市312030 [2]绍兴市柯桥区社保局,浙江省绍兴市312030

出　　处：《现代医院管理》2017年第5期61-65,共5页Modern Hospital Management

摘　　要：目的评估医保总额预算制的实施对医保支出及医疗行为的影响。方法收集我院2009—2015年的医保相关数据,并从全院和科室两个维度分别分析,为医院及各科室提供参考;通过医患问卷调查及关键知情人访谈,了解改革对医疗行为和管理产生的影响。结果门诊患者人次人头比有上升倾向,住院患者改变不明显,而次均费用自总额预算制实施后呈缓慢递减趋势;大部分医患对改革持满意态度,但对配药限制政策存在不满,同时该制度实施过程中在指标科学性、信息透明度等方面存在不足。结论医保总额预算制会影响医院管理行为,是控制医疗费用的有效办法,但在配药限制政策、医保指标科学性、信息透明度等方面仍需进一步改进。Objective: To evaluate the impact of the implementation of the total health budget system on health care and medical behavior. Method: The authors collected the data from 2009 to 2015 and analyzed from tw o dimensions of the hospital and the departments,and provided the reference for hospitals and departments so as to understand the impact of the reform on medical behavior and management through the questionnaire survey and interview w ith key insiders. Result: The ratio of patients w ith outpatient visits has an upw ard tendency but the inpatient changes are not obvious. The subtotal average cost is slow ly decreasing after the total budget system is implemented. M ost doctors and patients are satisfied w ith the reform,but they are dissatisfied w ith the policy of dispensing restrictions,and there are insufficient indicators in the implementation of the system in terms of the scientificity and information transparency. Conclusion: Total health budget system w ill affect hospital management behavior,and it is an effective w ay to control medical expenses,but further improvement in dispensing limit policy,scientificity of health insurance indicators,and the information transparency is still to be done.

关 键 词：医保总额预算 时间序列分析 医保支付制度 医疗费用 

分 类 号：R197[医药卫生—卫生事业管理]