| 引用本文: |
蒋艳,满晓玮,赵丽颖,等.北京市“医药分开”“医耗联动”改革前后不同来源患者治疗费用机构流向变化研究*[J].中国卫生经济,2022,41(8):29-33.[点击复制] |
Jiang Yan,Man Xiaowei,Zhao Liying,et al.Analysis on the Changes of Institution Flow before and after the Comprehensive Reform for the Treatment Costs of Patients from Different Sources in Beijing[J].CHINESE HEALTH ECONOMICS,2022,41(8):29-33.[点击复制] |
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| 摘要: |
| 目的：通过分析北京市“医药分开”“医耗联动”综合改革前后本地居民和外来就医患者治疗费用、服务量的机构流向变化，为下一步政策的制定提供数据支持。方法：运用多阶段分层、整群抽样调查的方法，以卫生费用核算体系2011 为基础，核算2016—2019年北京市不同级别医疗机构不同来源患者治疗费用情况。结果：2016—2019年社区卫生机构治疗费用增长最快，治疗费用和服务量占比均呈上涨趋势。本地居民治疗费用、门诊服务主要由三级医院流向社区卫生服务机构。 2019年，三级医院住院患者服务量占比由 50.19%增至 53.12%，外来就医患者门诊、住院的费用和服务量占比均有小幅度增长。在相同级别机构中，外来就医患者次均费用均高于本地居民，三级医院住院次均费用差异逐渐减小，二级医院住院患者次均费用差距增大。结论：北京市综合医改后治疗费用流向逐年优化，改革有效分流二三级医院门诊患者，使其流向社区， 优化本地居民门诊患者流向的效果明显，应该加大基层医疗机构服务能力建设。医耗联动改革可能在一定程度上增加三级医院的吸引力，尤其是对外来就医患者的吸引力，因此，应合理配置首都高质量医疗资源。 |
| 关键词: 本地居民 外来就医 治疗费用 医药分开综合改革 医耗联动综合改革 北京 |
| DOI： |
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| 基金项目:北京市卫生健康委员会“2020年基于 SHA2011的北京市经常性卫生费用核算”项目(BUCM-2021-KJ-GL007) |
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| Analysis on the Changes of Institution Flow before and after the Comprehensive Reform for the Treatment Costs of Patients from Different Sources in Beijing |
| Jiang Yan,Man Xiaowei,Zhao Liying,Cai Dongxia,Liu Liming,Cheng Wei |
| (Beijing University of Chinese Medicine, Beijing, 100029 , China) |
| Abstract: |
| Objective: To provide the references for the allocation and adjustment of health policy of Beijing in the next step by analyzing the changes in the institutional flow of residents and outsiders for medical treatment expenses and service volume before and after the comprehensive reform of “medical-pharmaceutical separation" and “medical consumption linkage" in Beijing. Methods: Based on A System of Health Accounts 2011 (SHA 2011), a multi-stage stratified cluster sampling method was used to calculate the treatment costs of patients from different medical institutions from 2016 to 2019. Results: From 2016 to 2019 , the community medical and health institutions had the fastest growth in the treatment costs of medical institutions in Beijing and the proportion of treatment costs and service volume showed an upward trend year by year. Residents' treatment costs and outpatient services mainly flowed from tertiary hospitals to community health service institutions. In 2019, the proportion of service volume of inpatient service volume in tertiary hospitals increased from 50.19% to 53.12%,and the cost and service volume of outpatient clinics and inpatients in tertiary hospitals increased slightly. The average cost per visit of non-residents patients in institutions of the same level was higher than that of residents, the difference in the average cost per inpatient visit in tertiary hospitals was gradually decreasing, and the difference in the average cost per inpatient hospitalization in secondary hospitals increased. Conclusion: After the comprehensive medical reforms in Beijing, the flow of treatment costs had been optimized year by year, it had effectively diverted the flow of outpatients from secondary and tertiary hospitals to the communities. The optimization of the flow of outpatients for residents had achieved obvious results. The service capacity building of primary medical institutions should be strengthened. The reform of medical consumption linkage might increase the attractiveness of tertiary hospitals to a certain extent, especially for non-residents patients, and the capital's high-quality medical resources should be allocated reasonably. |
| Key words: local resident non-residents' medical care curative expense comprehensive reform of medical-pharmaceutical separation comprehensive reform of medical consumption linkage Beijing |
