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按人头支付政策干预对患者门诊服务利用的影响分析
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Impact Analysis of Outpatients Medical S ervice Utility by the Policy Intervention of Capitation Payment
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    摘要:

    目的:分析按人头支付政策干预对参合对象门诊服务利用的相关影响。方法:收集2011-2015年浦东新区按人头支付干预前后新型农村合作医疗参合对象门诊服务利用相关数据,通过比较分析,评价政策干预对参合对象门诊服务利用的影响。结果:80%的门诊服务利用发生在社区卫生服务机构,16%发生在二级医院;从费用来看,社区卫生服务机构和二三级医疗机构的门诊医疗费用各占一半;从环比增速来看,按人头支付政策干预后患者的次均门诊费用呈逐年下降的趋势,2015年二三级医疗机构参合对象次均门诊费用分别为275.46元和208.24元。结论:参合对象的总体门诊服务利用次数和费用均逐年增加,二三级医疗机构就诊增加明显;政策干预后对参合对象次均门诊费用控制较好,尤其二三级医院下降明显。

    Abstract:

    Object: To evaluate the effect of capitation payment policy intervention for medical service utility of the insured o utpatients. Methods: To collect outpatients’ medical service utility data before and after the capitation payment policy intervention in NCMS in pudong new area from the year of 2011 to 2015 , and to a nalyze the intervention impacts on o utpatients’ medical service utility by comparison. Results: 80% outpatients’ medical service utility was happened in community health service centers (CHSCs) and 16% was happened in secondary hospitals. The institution of outpatients’ expense was roughly equally split between CHSCs and second & th ird degree hospital s. From the view of year-over-year growth , it resulted in a downward trend of outpatient cost per visit year by year after the intervention, and in the year of 2015 the mean outpatient cost per visit in second & th ird degree hospital s respectively were RMB 275.46 and RMB 208.24. Conclusion: The times and fees of insured outpatients were generally going up year by year, especially in second & th ird degree hospital s. There was a well impact of the policy intervention in cost control of outpatient cost per visit, and also there was a more obvious downward trend in second & th ird degree hospitals.

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李明,舒之群,黄煊,等.按人头支付政策干预对患者门诊服务利用的影响分析[J].中国卫生经济,2017,(7):41-43.按人头支付政策干预对患者门诊服务利用的影响分析[J]. CHINESE HEALTH ECONOMICS,2017,(7):41-43.

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