医共体总额预付对基层医疗服务供给的影响分析——基于湖北省黄冈市黄州区的实证研究  

Analysis of the impact of total prepayment of County Medical Alliance on the supply of primary medical services: An empirical study in Huangzhou District, Huanggang City, Hubei Province

作　　者：周津 贺琼 王军 童惠 钟正东 项莉[1] ZHOU Jin;HE Qiong;WANG Jun;TONG Hui;ZHONG Zheng-dong;XIANG Li(HUST Base of National Institute of Healthcare Security,School of Medicine Health Management of Tongji Medical College of Huazhong University of Science and Technology,Wuhan Hubei 430000,China;Huanggang Huangzhou General Hospital,Huanggang Hubei 438000,China)

机构地区：[1]国家医疗保障研究院华科基地华中科技大学医药卫生管理学院,湖北武汉430000 [2]黄冈市黄州总医院,湖北黄冈438000

出　　处：《中国卫生政策研究》2022年第8期41-47,共7页Chinese Journal of Health Policy

基　　金：国家自然科学基金项目(71874058;72174068);中央高校基本科研业务费(YCJJ202204018)。

摘　　要：目的:分析总额预付制改革对黄州区医共体基层医疗服务供给的影响。方法:收集黄州区医共体月度数据,描述性分析基层医疗服务供给能力、效率及数量的变化,利用间断时间序列检验总额预付两次政策改革前后服务供给数量的变化情况。结果:黄州区分别于2018年、2019年开展并完善总额预付制改革。改革后,基层卫生技术人员占比、医师日均诊疗人次及床位使用率总体呈增长趋势。两阶段政策改革后基层门急诊人次及其占比均呈增长趋势(P<0.05),第一阶段政策改革后出院人数及其占比显著增长(P<0.05)。结论:总额预付制促进了基层医疗服务供给增加,但仍存在门急诊服务量增长趋势平缓、住院服务量不合理增长的问题,第二阶段政策改革应进一步扩大总额预付改革成果。Objective: To analyze the impact of total prepayment reform on the primary medical service supply of County Medical Alliance in Huangzhou District. Methods: The monthly data of the County Medical Alliance in Huangzhou District were collected, and the changes in the supply capacity, efficiency and quantity of primary medical services were analyzed descriptively. The changes in the amount of primary medical service supply before and after the two times of total prepayment policy reform were examined at intermittent time series. Results: Huangzhou District carried out and improved the total prepayment reform respectively in 2018 and 2019. After the reform, the proportion of primary health care technicians, the daily patient visit number per physician and the rate of bed utilization showed an overall increasing trend. After the two stages of policy reform, the number of primary outpatient and emergency visits and their proportion showed an increasing trend(P<0.05), and the number of discharges and its proportion increased significantly after the first stage of policy reform(P<0.05). Conclusions: The total prepayment policy facilitated the increase of primary medical service supply. However, certain problems still remain, such as the slow growing trend of the amount of outpatient and emergency services and the unreasonably fast increase of the amount of inpatient services. The second stage policy reform further improved the effect of total prepayment reform.

关 键 词：紧密型医共体 总额预付 医疗服务供给 基层医疗卫生机构 

分 类 号：R197[医药卫生—卫生事业管理]