西部某省乡镇卫生院门诊按人头付费政策实施的影响因素研究  

Study on Influencing Factors of the Implementation of Capitation Payment Policy in Outpatient Services at Township Health Centers in a Western Province

作　　者：陈玮琢 肖雯琪 房慧妍 叶婷[1,2] CHEN Weizhuo(School of Medicine and Health Management,Tongji Medical College,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》2025年第1期87-94,共8页Medicine and Society

基　　金：国家自然科学基金资助项目,编号为72074087;教育部人文社会科学研究青年项目资助(嵌入性视域下居民对家庭医生信任的形成机理、动态模型与优化策略研究,20YJC630193)。

摘　　要：目的:分析西部某省乡镇卫生院门诊按人头付费政策实施的影响因素,为进一步完善门诊按人头付费提供参考依据。方法:于2023年12月,通过对西部某省3个门诊按人头付费拟试点县的关键知情人进行深度访谈,基于实施性研究综合框架,采用演绎性主题分析识别乡镇卫生院门诊按人头付费政策实施的影响因素;通过建立解释结构模型,深入探究影响因素间的层次关系。结果:从政策因素、外部因素、内部因素、个体特征4个主题总结乡镇卫生院门诊按人头付费政策实施的13个影响因素,共分为3个层级,政策支持力度是推动门诊按人头付费政策实施的根本因素,合理的政策要素是中间因素,基层医疗卫生服务能力是直接因素。结论:根据政策实施影响因素的层次结构,为推动乡镇卫生院门诊按人头付费政策的有效实施,需构建政府为主导的多部门协同支持体系,增强按人头付费政策设计的科学性和合理性,提升基层医疗卫生服务能力。Objective:To analyze the influencing factors of the implementation of the capitation payment policy in outpatient services at township health centers in a western province,with the aim of providing a reference for further improving outpatient capitation payment.Methods:Through in-depth interviews with key informants in 3 counties preparing to pilot outpatient capitation and based on the consolidated framework for implementation research,a deductive thematic analysis was utilized to organize the factors influencing the advancement of outpatient capitation payment in township health centers in a western province in December 2023.Additionally,by constructing the interpretative structural modeling,the hierarchical relationship among influencing factors was thoroughly investigated.Results:Thirteen influencing factors identified in the implementation of the outpatient capitation payment policy in township health centers were categorized into three levels from four themes of policies factors,external factors,internal factors and individual characteristics.The fundamental factor driving the implementation of the capitation payment policy in outpatient services was the support strength of the policy,with rational policy elements serving as intermediate factors,and the capability of grassroots medical and health service as the direct factor.Conclusion:According to the hierarchical structure of factors influencing the implementation of policy,through the construction of a government-led multisectoral synergistic support system,the scientific and rational nature of the capitation policy design will be enhanced,and the capacity of the grassroots medical and health service will be upgraded,so as to promote the effective implementation of outpatient capitation payments at township health centers.

关 键 词：医保支付方式 按人头付费 门诊 乡镇卫生院 

分 类 号：R-05[医药卫生] R197.1