摘要
目的了解基于病种的分级诊疗制度实施后对新型农村合作医疗（简称新农合）住院患者流向和由此导致的基金分流及医疗费用的影响。方法选取实施基于病种的分级诊疗制度的东、中、西部各1个县为对象，梳理制度文件，分析制度实施前后新农合住院患者流向、住院补偿基金分流、新农合基金当年结余率以及次均住院费用的变化。结果与2014年相比，2015年西部w县住院患者县外就医比例下降了1．26个百分点，中部D（县级）市的乡级住院人次占比增加2．00个百分点，东部F县住院患者县外就医比例基本持平。与2014年相比，2015年W县新农合基金当年结余率提高了10．46个百分点，D（县级）市县外医疗机构住院补偿基金占比下降了2．51个百分点。W县实施总额预付下按病种定额付费，县乡两级医疗机构的次均住院费用均有下降。结论基于病种的分级诊疗制度，优化了新农合住院患者在不同级别医疗机构的分布，有利于分级诊疗秩序的建立。
Objective To understand the influence of the disease-based hierarchical medical system on inpatients flow covered by the new rural cooperative medical system （NRCMS） , and that on the funding diversion and medical costs so incurred. Methods One county was selected from the eastern, central and western regions of China respectively, where the disease-based hierarchical medical system has been in place. Policy documents of the three counties were reviewed to analyze such changes as NRCMS inpatients flow, inpatients subsidy diversion, NRCMS fund surplus rate of the current year and medical costs per hospitalization before and after the system was in place. Results A comparison with 2014 found a 1.26% drop of the out-of-county inpatients of county W of the western region, a 2.00% increase of township hospitals inpatients of county D in the middle region, and the same ratio of out-of-county and in-county inpatients in county F of the eastern region in 2015. Compared with 2014, the fund surplus rate of county W increased 10.46% , and the inpatient subsidy ratio of county D decreased 2.51% for those in out-of-county medical institutions in 2015. Thanks for the quota payment of specific diseases under global budget in county W, the inpatient medical costs per hospitalization dropped at both county and township medical institutions. Conclusions The disease-based hierarchical medical system could optimize the NRCMS inpatients distribution among various medical institutions, conducive for establishment and operation of such a system.
出处
《中华医院管理杂志》
CSCD
北大核心
2017年第1期7-10,共4页
Chinese Journal of Hospital Administration
基金
国家卫生计生委基层卫生司委托课题（2015）
关键词
新型农村合作医疗
分级诊疗
病种
住院患者流向
基金分流
New rural cooperative medical care
Hierarchical medical system
Diseases
Inpatients flow
Fund diversion
