区域按人头总额预付对安徽省两县常见慢性病住院患者就医流向的影响  

Effect of Regional Global Budget Based on Per Capita on the Flow Direction of Inpatients with Common Chronic Diseases in Two Counties in Anhui Province

作　　者：雷诗寒 陈迎春[1,2] 苏岱 常静肼 胡晓梅 姜迪[1] 谭敏[1] 陈芝芳 LEI Shi-han(School of Medicine and Health Management,Tongji Medical College of Huazhong University of Science and Technology,Wuhan,Hubei,430030,China)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,湖北武汉430030 [2]湖北省人文社科重点研究基地农村健康服务研究中心,湖北武汉430030

出　　处：《医学与社会》2020年第12期104-108,118,共6页Medicine and Society

基　　金：国家自然科学基金资助项目,编号为71673101。

摘　　要：目的:探讨县域医共体按人头总额预付对常见慢性病住院患者就医流向的影响,为推进分级诊疗制度提供参考。方法:对安徽省定远县和阜南县实施医共体按人头总额预付前后两年的高血压、糖尿病、慢阻肺住院患者分级诊疗相关数据进行比较分析。结果:较2014年,2016年定远县常见慢性病住院患者县外医疗机构住院占比下降5.25%,乡级医疗机构住院占比增加7.86%;县级医疗机构住院补偿基金占比增加4.55%,乡级占比增加2.90%。较2014年,2016年阜南县常见慢性病县外住院人次占比减少1.18%,县级住院人次占比增加13.75%;县级医疗机构住院补偿基金占比增加12.99%,但乡级占比减少10.09%。结论:区域按人头总额预付有利于常见慢性病住院患者向县域内流动,但在改革初期,部分患者次均住院费用仍有增长,需采取科学的配套措施促使常见慢性病住院患者县域内就医流向趋于合理,控制医疗费用。Objective:To explore the effect of regional global budget based on per capita on the flow direction of inpatients with common chronic diseases,so as to provide reference for promoting the system of tiered medical services.Methods:A comparative analysis was made on the data related tiered medical services of inpatients with hypertension,diabetes and chronic obstructive pulmonary before and after the implementation of payment reform in Dingyuan and Funan counties of Anhui province.Results:Compared with 2014,in 2016,the proportion of inpatients of common chronic diseases in out-of-county medical institutions in Dingyuan decreased by 5.25%,the proportion of inpatients in township medical institutions increased by 7.86%,the proportion of compensation funds in county medical institutions increased by 4.55%,and the proportion in township medical institutions increased by 2.90%.Compared with 2014,in 2016,the proportion of inpatients of common chronic diseases in out-of-county in Funan decreased by 1.18%,the proportion of inpatients in county increased by 13.75%,the proportion of compensation funds in county medical institutions increased by 12.99%,but the proportion in township decreased by 10.09%.Conclusion:The regional global budget based on per capita is conducive to the flow direction of inpatients to the county,but in the early stages of reform,the average hospitalization expense of some common chronic diseases inpatients increased.Scientific measures should be taken to help the flow of inpatients with common chronic diseases flow reasonable in the county and control the medical expenses.

关 键 词：常见慢性病 住院患者 流向 区域按人头总额预付 

分 类 号：R195[医药卫生—卫生统计学]