| 引用本文: |
倪剑潇,高广颖,赵宁,等.基层门诊慢性病按人头付费测算方法比较研究*[J].中国卫生经济,2023,42(7):21-26.[点击复制] |
Ni Jianxiao,Gao Guangying,Zhao Ning,et al.Comparative Study on the Calculation Methods of Chronic Diseases by Capitation in Primary Clinics[J].CHINESE HEALTH ECONOMICS,2023,42(7):21-26.[点击复制] |
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| 摘要: |
| 目的：基于4种主要慢性病的实证数据比较测算基准人头费的两种方法，为我国推进以慢性病为主的门诊按人头付费提供方法学参考。方法：收集北京市大兴区患有4种慢性病的参保人数据，通过自上而下和自下而上两种方法测算按人头付费标准，比较测算结果及测算方法的优劣。结果：自上而下测算的高血压、糖尿病、脑血管3类患者人头费标准高于自下而上法测算的结果，自下而上法测算出的居民医保缺血性心脏病人头费标准较低，但不管用哪种方法职工医保测算出的结果均高于居民医保。自下而上法是基于历史数据测算的，结果更加符合实际。结论：自下而上测算人头费的方法对于我国现阶段来说相对科学合理。在地区内试行几年按人头付费后，再采用自上而下法可以更方便快捷地测算人头费标准。 |
| 关键词: 基层门诊 慢性非传染性疾病 按人头付费 测算方法 |
| DOI： |
| 投稿时间：2023-05-03 |
| 基金项目:基金项目：国家医疗保障研究院开放性课题 （YB2020B05，YB2020B05） |
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| Comparative Study on the Calculation Methods of Chronic Diseases by Capitation in Primary Clinics |
| Ni Jianxiao,Gao Guangying,Zhao Ning,Gu Mei,Wu Nina,Yang Jia |
| (Party Committee Office, Fangzhuang Community Health Service Center, Beijing, 100078 , China) |
| Abstract: |
| Objective: Based on the empirical data of four major chronic diseases, to compare the two methods of calculating the benchmark capitation, and to provide methodological references for promoting the reform of the capitation payment mode of outpatient services with chronic diseases in China. Methods: The data of urban employees and urban and rural residents in Daxing District who suffer from the above four types of chronic diseases were collected to calculate the capitation rate by top-down and bottom-up methods, and compare the advantages and disadvantages of the calculation results and methods. Results: The capitation standard of hyper- tension, diabetes and cerebrovascular patients calculated from top to bottom was higher than that calculated from bottom to top. The capitation standard of ischemic heart patients with resident medical insurance calculated from bottom to top was lower, but no matter which method was used, the results calculated from employee medical insurance were higher than that of resident medical insurance. The bottom-up method was based on historical data, and the results were more realistic. Conclusion: The bottom-up method for cal- culating the headcount is relatively scientific and reasonable for China at this stage. After several years of trial implementation of capi- tation in the region, the top-down method can be used to calculate the capitation standard more conveniently and quickly. |
| Key words: payment by capitation outpatient chronic disease calculation method |
