补偿机制改革对县医院医疗服务利用情况的影响分析
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摘要
目的了解补偿机制改革对县医院医疗服务利用情况的影响。方法以山东省某县级公立医院门诊和住院患者的微观数据为基础,利用多元回归模型以及间断时间序列的分段回归模型,分析补偿机制改革与诊疗费用及服务量之间的关系,评价改革对医疗服务利用情况的影响。结果患者改革后门诊和住院的服务量下降,变化趋势也明显下降。门诊费用提高,住院费用下降,但变化趋势均明显下降。结论补偿机制改革对医疗服务利用的影响积极与消极并存。如何激励医院提供服务、激励患者合理利用服务是下一步改革需要解决的问题之一。
Objective To evaluate the impact of compensation mechanism reform on medical service utilization of county-level public hospitals.Methods Based on the outpatient and inpatient micro data as patients' medical information from a county-level hospital in Shandong province,multiple linear regression and interrupted time series segmented regression were employed to analyze the relationship between the reform and medical costs,as well as service volume,and to evaluate the impact of the reform on medical service utilization.Results After the compensation mechanism reform,both outpatient and inpatient medical service volumes decreased,and their changing trends all declined obviously.Inpatient expenses decreased but outpatient expenses increased,while their changing trends all declined obviously.Conclusion Both positive and negative effects of the reform on medical service utilization are shown in this study.How to encourage hospitals to provide services and to inspire patients to utilize services rationally is one of the problems that should be solved in the next stage of reform.
Objective To evaluate the impact of compensation mechanism reform on medical service utilization of county-level public hospitals.Methods Based on the outpatient and inpatient micro data as patients' medical information from a county-level hospital in Shandong province,multiple linear regression and interrupted time series segmented regression were employed to analyze the relationship between the reform and medical costs,as well as service volume,and to evaluate the impact of the reform on medical service utilization.Results After the compensation mechanism reform,both outpatient and inpatient medical service volumes decreased,and their changing trends all declined obviously.Inpatient expenses decreased but outpatient expenses increased,while their changing trends all declined obviously.Conclusion Both positive and negative effects of the reform on medical service utilization are shown in this study.How to encourage hospitals to provide services and to inspire patients to utilize services rationally is one of the problems that should be solved in the next stage of reform.
引文
[1]翟婷婷,杨金侠,江洁.取消“以药补医”县级公立医院的补偿机制改革研究[J].中国卫生事业管理,2013,30(2):86-87,96.
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[5]刘晓婷,惠文.省级公立医院补偿机制改革对医保基金支出和个人负担的影响[J].公共行政评论,2015,8(5):30-49,186-187.
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[7]周琦荟,刘海容,葛惠雄.医疗服务价格调整对医院业务收入的影响[J].医院管理论坛,2014,31(11):22-24.
[8]陈丽,杨洪伟,梁小云,等.基本药物制度对基层卫生机构月门诊量的影响评价[J].中国医院管理,2013,33(11):72-73.
[9]张敏,赵琨,李雪,等.青岛市某医院临床路径改革对医疗费用影响的ITS分析[J].中国卫生经济,2016,35(2):67-68.
[10]陈丽,宋运鲁,吴琼,等.补偿机制改革对县级公立医院业务收入及结构的影响[J].中国医院管理,2016,36(10):14-17.
[2]饶克勤.公立医院筹资与补偿机制[J].中华医院管理杂志,2015,31(3):161-163.
[3]傅炽良,阳建民.深圳市实施药品零加成政策对公立医院住院费用的影响[J].中国医院管理,2013,33(2):4-6.
[4]王曦,明少兰.鄂州市公立医院取消药品加成的效果与思考[J].中国药物经济学,2013,8(3):49,183.
[5]刘晓婷,惠文.省级公立医院补偿机制改革对医保基金支出和个人负担的影响[J].公共行政评论,2015,8(5):30-49,186-187.
[6]冯虹,方敏.取消药品加成政策在某县级公立医院的实施效果评价[J].中国药房,2015,26(6):724-726.
[7]周琦荟,刘海容,葛惠雄.医疗服务价格调整对医院业务收入的影响[J].医院管理论坛,2014,31(11):22-24.
[8]陈丽,杨洪伟,梁小云,等.基本药物制度对基层卫生机构月门诊量的影响评价[J].中国医院管理,2013,33(11):72-73.
[9]张敏,赵琨,李雪,等.青岛市某医院临床路径改革对医疗费用影响的ITS分析[J].中国卫生经济,2016,35(2):67-68.
[10]陈丽,宋运鲁,吴琼,等.补偿机制改革对县级公立医院业务收入及结构的影响[J].中国医院管理,2016,36(10):14-17.