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DRGs点数付费对县域医共体建设效果的影响:以浙江省金华市为例
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杭州师范大学

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国家自然科学基金(71974050);杭州师范大学科研启动项目(4265C50221204120)


The Influence of DRGs Point Payment on the Construction Effect of County Medical Alliance: A Case Study of Jinhua City, Zhejiang Province
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Hangzhou Normal University

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The National Natural Science Foundation of China (General Program, Key Program, Major Research Plan);The Scientific Research Foundation for Scholars of HZNU

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    摘要:

    目的:分析评价DRGs点数付费对县域医共体建设效果的影响,以期为医共体的建设和完善提供证据。方法:选取金华市4个县域医共体以及6家市级医院,收集医疗服务量、费用负担、收入结构方面的数据,通过指数平滑法得到各测量指标2018-2020年的预测值,运用“投射—实施后”对比分析方法比较政策实施前后各级医院测量指标的变化。结果:2019年县级医院门急诊人次数差异度为13.75%,乡镇卫生院出院人数的差异度为23.08%;2020年县级医院、乡镇卫生院的住院费用的差异度分别为-8.59%和-13.92%;2020年县级医院卫生材料占比差异度为-24.86%。结论:DRGs点数付费增加了县域内患者的就诊量、降低了住院费用,并优化了县级医院的收入结构,但县域患者“趋高就医”依然突出、对市级医院的控费效果不明显,且药品耗材占比仍处高位。建议后续持续完善DRGs点数法付费设计,强化医保支付方式在县域医共体建设中的引导性作用以及完善相关配套措施。

    Abstract:

    Objective: This paper analyzes and evaluates the effect of DRGs point payment scheme on the construction of county medical alliance, in order to provide evidence for the construction and improvement of medical alliance. Methods:Four county medical alliances and six municipal hospitals in Jinhua were selected to collect data on medical service volume, cost burden and income structure. The predicted values of each measurement index from 2018 to 2020 were obtained through the exponential smoothing method. The comparative analysis method of “Projection-after implementation” was used to compare the changes of measurement indexes of hospitals at all levels before and after the implementation of the policy. Results: In 2019, the difference in the number of outpatient and emergency patients in county-level hospitals was 13.75%, and the difference in the number of discharged patients in township hospitals was 23.08%. In 2020, the difference of hospitalization expenses in county-level hospitals and township hospitals was -8.59% and -13.92%, respectively. In 2020, the proportion difference of sanitary materials in county-level hospitals was -24.86%. Conclusion: DRGs point payment has increased the number of patients in the county, reduced hospitalization costs, and optimized the income structure of county-level hospitals. However, county-level patients" higher medical treatment is still prominent, the effect of cost control on municipal hospitals is not obvious, and the proportion of drugs and consumables is still large. It is recommended to continue to improve the DRGs point payment scheme design and strengthen the guiding role of medical insurance payment scheme in the construction of county medical alliance and improve relevant supporting measures.

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陆贝茵,张涛,王小合. DRGs点数付费对县域医共体建设效果的影响:以浙江省金华市为例[J].中国卫生经济,,().

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  • 收稿日期:2022-05-26
  • 最后修改日期:2022-07-09
  • 录用日期:2022-08-11
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