公立医院改革对某驻地军队医院门诊费用的影响
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摘要
目的根据公立医院的改革政策,重点分析其对驻地军队医院门诊医疗费用的影响,为军队医院参与城市公立医院综合改革试点提供决策依据。方法收集武警江苏总队医院2005—2015年门诊就诊人次,利用SAS 9. 3软件对门诊人次构成比、门诊不同身份、费别、性别及年龄患者门诊次均费用进行数据分析与研究。结果 (1)次均费用呈逐年递增趋势,年均增长率为9. 7%;(2)门诊患者中地方人员占绝大多数,为95. 6%,且地方患者和军队患者的门诊费用差异有统计学意义(Z=47. 2066,P <0. 0001);(3)自费患者占门诊例数最多为84. 0%,其次为城镇医保患者10. 3%,且不同费别患者的门诊费用有统计学差异(χ2=41624. 2737,P <0. 0001);(4)男性患者占总门诊人次的54. 4%,高于女性患者,且不同年份男性与女性构成比差异有统计学意义(CMH=40. 6312,P <0. 0001);(5)门诊患者中人数最多的为35～59岁年龄组(49. 6%),且不同年份年龄构成比差异有统计学意义(χ2=2701. 3116,P <0. 0001)。结论该地区根据实际情况制定的医保政策起到了控制医疗费用过快增长的作用,在国家公立医院改革背景下,军队医院军民融合式发展是解决军队医院发展瓶颈问题的有效形式。
Objective To explore the influence of public hospital reform on outpatient expenses in a military hospital in order to provide evidence for the participation of military hospitals in the reform of urban public hospitals. Methods All the outpatients treated in this hospital between 2005 and 2015 were investigated. Descriptive analysis was performed using SAS 9. 3. The main indexes included the constituent ratio of outpatients and mean expenses. Results The mean expenses increased year by year,with a CAGR of 9. 7%. The majority of the outpatients were local residents,who accounted for 95. 6%,and there was significant difference( Z = 47. 2066,P < 0. 0001)in medical expenses between local and military outpatients. Self-pay outpatients( 84. 0%) were dominating in outpatient service,followed by outpatients( 10. 3%) covered by urban medical insurance,and there was significant difference( χ2= 41624. 2737,P < 0. 0001) in medical expenses between outpatients who paid for health care differently. Male patients accounted for 54. 4%,who outnumbered female ones. The difference between the two groups was of statistical significance( CMH = 40. 6312,P < 0. 0001). Most of the outpatients aged 35 to 59,accounting for 49. 6%. There was significant difference( χ2= 2701. 3116,P < 0. 0001) in the age of these outpatients. Conclusions Regulations on health care enforced in this area can help control the excessive growth of medical expenses. The integrated civilian-military development is an effectual solution to the bottleneck problem facing military hospitals under the context of public hospital reform. effectual way to solve the bottleneck problem of military hospitals under the context of public hospital reform.
Objective To explore the influence of public hospital reform on outpatient expenses in a military hospital in order to provide evidence for the participation of military hospitals in the reform of urban public hospitals. Methods All the outpatients treated in this hospital between 2005 and 2015 were investigated. Descriptive analysis was performed using SAS 9. 3. The main indexes included the constituent ratio of outpatients and mean expenses. Results The mean expenses increased year by year,with a CAGR of 9. 7%. The majority of the outpatients were local residents,who accounted for 95. 6%,and there was significant difference( Z = 47. 2066,P < 0. 0001)in medical expenses between local and military outpatients. Self-pay outpatients( 84. 0%) were dominating in outpatient service,followed by outpatients( 10. 3%) covered by urban medical insurance,and there was significant difference( χ2= 41624. 2737,P < 0. 0001) in medical expenses between outpatients who paid for health care differently. Male patients accounted for 54. 4%,who outnumbered female ones. The difference between the two groups was of statistical significance( CMH = 40. 6312,P < 0. 0001). Most of the outpatients aged 35 to 59,accounting for 49. 6%. There was significant difference( χ2= 2701. 3116,P < 0. 0001) in the age of these outpatients. Conclusions Regulations on health care enforced in this area can help control the excessive growth of medical expenses. The integrated civilian-military development is an effectual solution to the bottleneck problem facing military hospitals under the context of public hospital reform. effectual way to solve the bottleneck problem of military hospitals under the context of public hospital reform.
引文
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[8]汤元杰,刘沛,钟仕洋,等.“三医联动”下的武警医院门诊药占比情况分析[J].武警医学,2018,29(1):48-51.
[9]张凯,于晓萍,任海波,等.武警驻南疆某部卫生队2012-2016年疾病谱及成因分析[J].武警医学,2018,29(2):143-146.
[2]国务院办公厅.国务院办公室厅关于印发深化医药卫生体制改革2016年重点工作任务的通知[EB/OL].(2016-04-26). http://www. scio. gov. cn/32344/32345/33969/34689/xgzc34695/Document/1480540/1480540_1. htm.
[3]中国社保网. 2016年扬州医保支付方式调整方案解读[EB/OL].(2016-06-18). http://www. spicezee. com/zhishi/yiliao/134513. html
[4]扬州市统计局.扬州市2015年1%人口抽样调查主要数据公报[EB/OL].(2016-05-09). http://tjj. yangzhou. gov. cn/tjj/tjfx1/201605/edb6518fcd87486eacb4e7464e6ffb2c. html
[5]张志强,熊季霞.江苏省公立医院绩效工资改革问题与对策研究[J].中国卫生事业管理,2015,32(4):279-281.
[6]刘鹏程,吕笑冬.药品零差率下县级公立医院改革的SWOT分析[J].中国卫生事业管理,2015,32(1):31-32.
[7]李丹,张禹,张茜,等.军队医院基本医疗保险门诊费用的控制[J].解放军医院管理杂志,2015(12):1153-1155.
[8]汤元杰,刘沛,钟仕洋,等.“三医联动”下的武警医院门诊药占比情况分析[J].武警医学,2018,29(1):48-51.
[9]张凯,于晓萍,任海波,等.武警驻南疆某部卫生队2012-2016年疾病谱及成因分析[J].武警医学,2018,29(2):143-146.