摘要
目的分析社区签约服务对分级诊疗的影响,为完善分级诊疗制度提供依据。方法从杭州市医疗保险信息管理数据库中导出2015年杭州市基本医疗保险参保居民的就诊资料,分析不同医保类型参保人群在社区卫生服务机构就诊率,并按照是否签约家庭医生和年龄进行分层分析。结果截至2015年底杭州市主城区职工医保和城乡居民医保参保人数分别为288.99万人和17.41万人,家庭医生签约率分别为13.19%和50.89%。城乡居民医保参保人群社区卫生服务机构就诊率为77.22%,高于职工医保参保人群的51.26%(P<0.01)。职工医保参保人群中,签约对象社区卫生服务机构标化就诊率为55.06%,高于非签约对象的44.49%;城乡居民医保参保人群中,签约对象社区卫生服务机构标化就诊率为73.30%,低于非签约对象的80.98%。结论是否签约家庭医生是社区卫生服务机构就诊的影响因素,提升职工医保参保人群家庭医生签约率,可进一步推动杭州市居民分级诊疗制度的构建与实施。
Objective To analyze the influence of medical insurance paying proportion to hierarchical diagnosis and treatment,and to provide basis for the improvement of hierarchical diagnosis and treatment. Methods Data about average number of visits of insured residents in 2015 were obtained from Hangzhou medical insurance service database. Differences between visits to Community Health Service Centers（CHSC） of residents having Medical Insurance of Urban and Rural Residents（MIURR） and residents having Urban Employees＇ Basic Medical Insurance（UEBMI） were compared. And differences stratified by signed contracted services offered by General Practitioners（GPs） or not were further analyzed.Results Proportion of visits to CHSCs in all visits to medical institutions in residents with MIURR was 77.22%,which was significantly higher than the proportion in residents with UEBMI was 51.26%. In the residents with UEBMI,and the proportion of visits to CHSCs in all visits to medical institutions of the group sighed contracted services offered by GPs was significantly higher than the group non-sighed. Conclusion Increasing the gap between reimbursement ratio of CHSCs and higher medical institutions plays an important role in guiding health-seeking behavior of residents. Reformation of medical insurance payment and contracted services will guide residents to seek medical treatment and effective referral.
出处
《预防医学》
2017年第10期999-1002,共4页
CHINA PREVENTIVE MEDICINE JOURNAL
基金
杭州市科技发展计划项目(20150834M25)
杭州市卫生科技计划(一般)项目(2015A50)
关键词
医疗保险
统筹比例
分级诊疗
家庭医生签约
medical insurance paying proportion
hierarchical diagnosis
treatment
improvement
hierarchical diagnosis
treatment
