基于卫生费用视角的北京市基层医疗卫生资金的筹集与消耗状况研究  

The Financing and Components of Recurrent Health Expenses in Primary Healthcare Institutions in Beijing-based on SHA2011

作　　者：肖珊珊 满晓玮[1] 蒋艳[1] XIAO Shanshan;MAN Xiaowei;JIANG Yan(School of Management,Beijing University of Chinese Medicine,Beijing 102488,China)

机构地区：[1]北京中医药大学管理学院,北京市102488

出　　处：《中国全科医学》2024年第25期3115-3120,共6页Chinese General Practice

基　　金：2022年基于SHA2011的北京市经常性卫生费用核算(BUCM-2023-KJ-GL-005)。

摘　　要：背景基层医疗卫生机构是分级诊疗的关键环节,国家政策强调要深化“强基层”改革,发挥其“网底”作用。目的 了解北京市基层医疗卫生服务发展与资源利用情况,为下一步优化基层医疗卫生机构资源配置提供政策建议。方法 以SHA2011为基础,采用分层和简单随机抽样相结合的方法,共抽取医疗卫生机构29家。依据国际疾病分类(ICD)-10编码形成数据库,完成北京市经常性卫生费用核算。卫生费用总量数据来源于中国卫生健康统计年鉴、北京卫生健康统计年鉴、北京市政府卫生投入监测系统、北京市公共卫生信息中心等。核算2014—2020年基层医疗卫生机构卫生费用概况、筹资来源和功能流向(包括治疗服务费用和预防服务费用)。结果 基层卫生费用由122.31亿元增至327.61亿元,年均增速为15.53%,其占卫生费用的比重由7.93%增长至13.61%,基层卫生费用筹资方案以社会基本医疗保险方案、政府方案为主,家庭卫生支出占比由18.65%降至8.30%;治疗服务费用占比由87.49%波动下降至77.73%,主要由内分泌、中医、循环系统疾病这三类患者消耗,累计占比在60.00%以上,基层治疗服务的主要人群是60岁以上的老年患者,其费用占比由48.92%增至64.31%;预防服务费用的占比由12.51%波动增长至22.27%,基层预防服务资源主要由中医药健康管理、免疫规划、健康教育、老年人健康管理、慢性病管理等预防服务项目消耗。结论 分级诊疗成效初显,基层医疗资源发展迅速,在首都医疗卫生体系中发挥重要作用。政府承担基层重要筹资责任,居民个人负担下降,基层患者以老年、慢性非传染性疾病患者为主,预防服务能力不断提升,应针对需求,精准配置基层医疗卫生资源,关注重点公共卫生任务,把握服务新特点。Background Primary healthcare institutions are the key link in hierarchical diagnosis and treatment,and national policies emphasize the need to deepen the "strong grassroots" reform and play its role as the "bottom of the net".Objective To understand the development and resource utilization of primary healthcare services in Beijing,and provide policy suggestions for optimizing the resource allocation of primary healthcare institutions in the next step.Methods Based on SHA2011,a combined method of stratified and simple random sampling was used to select a total of 29 medical and health institutions.A database was formed based on the International Classification of Diseases(ICD-10) coding to complete the accounting of recurrent health expenses in Beijing.The data concerning Beijing health expenses were derived from China Health Statistics Yearbook,Beijing Health Statistics Yearbook,Beijing Municipal Government Healthcare Subsidies Monitoring System,Beijing Public Health Information Center,and so on.The overview,funding sources,and functional flow of health expenses (including treatment service expenses and prevention service expenses) in primary healthcare institutions from 2014 to 2020 were analyzed.Results The recurrent health expenses for Beijing's primary healthcare institutions increased from 12.231 billion yuan to 32.761 billion yuan,with an average annual growth rate of 15.53%,and its proportion in health expenses increased from 7.93% to 13.61%.The inputs were mainly from medical insurance reimbursement programs and Beijing municipal government subsidies,while the proportion of household health expenses has decreased from 18.65% to 8.30%.The proportion of treatment service expenses fluctuated from 87.49% to 77.73%,mainly consumed by endocrine,traditional Chinese medicine and circulatory system diseases,accounting for more than 60.00% cumulatively.The main population of primary treatment services was elderly patients over 60 years old,and the proportion of expenses increased from 48.92% to 64.31%.The proporti

关 键 词：卫生服务研究 分级诊疗 基层医疗卫生机构 经常性卫生费用 SHA2011 

分 类 号：R197[医药卫生—卫生事业管理]