基于患者视角的整合型医疗卫生服务体系“转诊机制”交易费用  

Transaction costs of the“referral mechanism”in integrated delivery systems:a patient perspective

作　　者：李淼军 朱东方 牛亚冬 王伟 苗豫东 LI Miaojun;ZHU Dongfang;NIU Yadong;WANG Wei;MIAO Yudong(Henan Medical Communication and Project Foward Center,Zhengzhou 450003,Henan,China;College of Public Health,Zhengzhou University,Zhengzhou 450001,Henan,China)

机构地区：[1]河南省医学交流和项目推进中心,河南郑州450003 [2]郑州大学公共卫生学院,河南郑州450001

出　　处：《健康发展与政策研究》2024年第6期511-516,523,共7页Health Development and Policy Research

基　　金：国家社会科学基金一般项目(21BGL222)。

摘　　要：目的了解患者对整合型医疗卫生服务体系“转诊机制”交易费用的认知状况,测量并比较城乡患者交易费用差异,为“转诊机制”的可持续发展提供证据支持。方法采用典型抽样法,选取青海省海西州D市紧密型县域医疗服务共同体、河南省郑州市J区城市医疗集团、山东省德州市N县健康管理联合体内发生上转或下转的高血压和糖尿病住院患者作为研究对象,调查其对交易费用的认知;基于威廉姆森-张五常交易费用分析范式建立交易费用测算方法,测量其转诊的次均交易费用,并通过倾向评分匹配比较城乡患者的交易费用。结果共调查915名转诊患者,其次均交易费用为647.68元,包括次均时间成本348.61元、专项投入成本299.07元;29.30%的转诊患者认为转诊过程中所需的成本较低或者非常低,近50.00%的患者认为转诊过程中所需的成本中等;男性、≥60岁、农村、受教育程度高、在业、转诊交通时间长、上转并下转的患者,交易费用相对高,差异均有统计学意义(P<0.05)。倾向评分匹配前后,城镇患者交易费用(600.24元、547.87元)均低于农村患者(671.51元、934.74元),差异均有统计学意义(P<0.001)。结论患者对转诊交易费用认知程度较低,在转诊过程中所承担的交易费用较高,且农村患者远高于城镇患者。建议供方层面畅通转诊渠道,需方层面提高交易费用认知水平和推动有序就医,保障方建立补偿激励措施,以有效应对交易费用。Objective To examine patients’awareness of the transaction costs of the“referral mechanism”in integrated medical and health service system,measure and compare the differences in transaction costs between urban and rural patients,and provide evidence to support the sustainable development of the mechanism.Methods A typical sampling method was used to select the hospitalized patients with hypertension and diabetes who turned up or down in the compact county-level medical community in D City of Haixi Prefecture,Qinghai Province,the urban medical group in J District of Zhengzhou City,Henan Province,and the health management union in N county of Dezhou City,Shandong Province,and patients’awareness of transaction costs was investigated.Based on the Williamson-Steven Cheung analysis paradigm,a method for transaction cost calculation was established to measure the average transaction cost per referral,and the transaction costs of urban and rural patients were compared by propensity score matching.Results A total of 915 referred patients were investigated,and the average transaction cost per referral was 647.68 CNY,including 348.61 CNY for the time cost and 299.07 CNY for special input cost.Over 29.29%of the referred patients considered that the cost of each part of the referral to be low or very low,while nearly 50%of the patients regarded them as moderate.The transaction costs were higher for male,younger,rural,highly educated,employed patients,those with longer referral transportation time,and those transferred both up and down.These differences were statistically significant(P<0.05).Before and after propensity score matching,the transaction costs of urban patients(600.24 CNY and 547.87 CNY)were lower than those of rural patients(671.51 CNY and 934.74 CNY),with the differences being statistically significant(P<0.001).Conclusions Patients have limited awareness of referral transaction costs,and the cost they incur in the process of referral is high,particularly for rural patients,whose costs are much higher than

关 键 词：整合型医疗卫生服务体系 转诊机制 交易费用 患者 

分 类 号：R19[医药卫生—卫生事业管理]