紧密型县域医共体医保打包支付对患者就诊流向的影响  

Effect of medical insurance package payment in compact county medical community on patient flows

作　　者：吴宜欣 李跃平 WU Yixin;LI Yueping(School of Health Management,Fujian Medical University,Fuzhou 350122,China;Library,Fujian Medical University,Fuzhou 350122,China)

机构地区：[1]福建医科大学卫生管理学院,福建福州350122 [2]福建医科大学图书馆,福建福州350122

出　　处：《南京医科大学学报（社会科学版）》2023年第2期144-149,共6页Journal of Nanjing Medical University（Social Sciences）

基　　金：福建省医改研究会委托课题“三明市公共卫生体系十年改革历程、成效与启示”(2022B030)。

摘　　要：为分析紧密型县域医共体医保打包支付对患者就诊流向的影响,选取福建省某国家试点医共体为研究对象,采用描述性分析和间断时间序列分析等方法研究该医共体实行医保打包支付前后患者就诊流向指标变化。结果显示,改革后门诊患者县域内就诊人次、县域就诊率上升,住院患者县域内住院人次占比下降趋势放缓;门诊患者基层就诊率下降,住院患者的基层住院人次及占比下降趋势放缓。医共体实行医保打包支付有助于引导患者回到县域内就诊,但尚未推动患者向基层分流。未来需进一步完善医保打包支付机制,提升医共体整体及基层服务能力,落实配套制度建设,引导患者合理就医。This study analyzed medical insurance package payment in the county medical community on patient flows by selecting a national pilot county medical community in Fujian as a sample population through descriptive analysis and interrupted time series analysis to study changes in the patient flow before and after the implementation of medical insurance package payment.The results showed that the outpatients’treatment volume and visit rate of the county were increasing,the decreasing trend of inpatient visit rate of the county slowed down;the outpatients’visit rate of basic⁃level medical institutions decreased,and the inpatients’treatment volume and visit rate of basic⁃level medical institutions also slowed down.Implementing medical insurance package payment in the county medical community helps to guide patients back to the county,while not yet promoting the patient flow to basic level medical institutions.It is necessary to further improve the mechanism of medical insurance package payment,the overall service capacity of the medical community,basic level medical institutions and implement the construction of the supporting systems to guide patients towards proper healthcare.

关 键 词：县域医共体 医保打包支付 患者流向 

分 类 号：R197.1[医药卫生—卫生事业管理]