福州市卫生资源供给结构与医疗费用增长结构差异的关系分析  

Relationship analysis between the supply structure of health resources with the growth structure of medical expenditure of Fuzhou

作　　者：李鑫梅 李跃平[2] Li Xinmei;Li Yueping(School of Public Health,Fujian Medical University,Fuzhou 350122,China;Health Research Institute,Fujian Medical University,Research Center for Healthcare Reform and Development of Fujian,Fuzhou 350122,China)

机构地区：[1]福建医科大学公共卫生学院,福州350122 [2]福建医科大学卫生健康研究院,福建省医疗改革与发展研究中心,福州350122

出　　处：《中华医院管理杂志》2021年第2期121-126,共6页Chinese Journal of Hospital Administration

基　　金：福建省自然科学基金(2018J01807)。

摘　　要：目的分析福州市卫生资源供给结构与医疗费用增长结构差异之间的关系。方法基于医院规模分类的标准,将中型和大型医院配置的卫生资源归为优质性卫生资源,而城市社区卫生服务中心、乡镇卫生院提供的卫生资源和床位<200张医院的卫生资源统归为基础性卫生资源,采用描述性统计方法分析福州市两类卫生资源配置和供给现状;利用结构分解法分解该市2016年至2019年住院费用,并通过主成分分析法讨论住院费用增长结构差异的影响因素。结果综合福州市各县区经济发展水平、卫生服务需求和地理位置等因素,将12个区/县划分成3类区域。一、二类区域配置的优质性卫生资源医疗机构数占全市总数的78.95%,其中,仅GL和TJ两区配备的住院床位达全市优质性住院床位总数的44.29%,三类区域配置则主要以基础性卫生资源为主。2016年至2019年,公立医院医疗费用持续增长。结构分解发现,规模效应是首要驱动因素,结构效应贡献次之,费用膨胀效应贡献率最小,说明住院服务利用增加是费用增长的主要原因。主成分回归结果显示,优质卫生资源供给的增加对住院费用增长呈现正向拉动作用,其中,大医院床位的扩张对费用膨胀效应具有正向影响(β_(1)=0.421,P<0.001)。基础卫生资源的配置对医疗费用过快增长能够起到一定收敛作用,而县区卫生资源配置总体水平负向影响患者的就诊流动(每千人口床位β_(2)=-0.303,P<0.001)。结论卫生资源供给结构与费用增长结构紧密相关。建议差异化配置优质和基础性卫生资源,优化资源供给结构。加强对基础性卫生资源的投入,增强相关机构的医疗卫生服务能力,从而优化居民就医流向,引导医疗费用的合理增长.Objective To analyze the relationship between the structure of health resource supply and the growth structure of medical expenditure in Fuzhou.Methods In accordance with hospital scale category standards,health resources provided for medium and large hospitals were categorized as high quality resources,while those provided for urban community health centers and township hospitals,and those for hospitals with less than 200 beds were categorized as primary health resources.The descriptive statistical method was used to analyze the health resource allocation and supply in Fuzhou;The structure decomposition method was used to decompose 2016—2019 hospitalization expenditure,and the principal component analysis was used to discuss the influencing factors of differences in the growth structure of hospitalization expenses.Results In accordance with such factors as the economic development level,health service needs and geographical locations of districts and counties of Fuzhou city,12 districts/counties were divided into three levels.The number of high-quality health resource medical institutions deployed in the first and second-level regions accounted for 78.95%of all.Among them,GL and TJ districts were equipped with hospital beds accounting for 44.29%of the total high-quality beds of all,while those resources of third-level regions were mostly primary health resources.From 2016 to 2019,medical expenditure of public hospitals kept rising.As found in structural decomposition,scale effect was the fundamental driver,followed by the structural effect,and then the inflation effect.This study identified increased inpatient service demand as the main driver for increased costs.Principal component regression results found that increased supply of high quality health resources as having a positive pull effect on the increase of hospitalization expenditure.For example,expansion of hospital beds at large hospitals contributes positive effect on the cost inflation(β_(1)=0.421,P<0.001).On the other hand,investment in primary hea

关 键 词：卫生资源 供给结构 医疗费用 结构分解 

分 类 号：R197.1[医药卫生—卫生事业管理]