摘要
目的:对县域内就诊率的概念、口径选择和数据可得性进行理论辨析,为衡量分级诊疗提供统一指标,为分级诊疗政策制定提供参考。方法:辨析4类主要医疗服务利用数据来源,从门急诊就诊率和住院率的含义与准确度分析其适用性,分析人群口径的选择的政策意义。结果:从医疗提供方统计县域内就诊率的难度大、成本高且准确性较低,而从医保端统计县域内就诊率则更加方便准确;因为县域内门急诊就诊率存在失真和异变性高的缺点,县域内就诊率应是指县域内住院率;分级诊疗关注焦点应是指参保人群而非常住或户籍人口。结论:应以县域内住院率衡量分级诊疗效果,而非笼统的县域内就诊率概念,县域医共体应改进病案首页的记录和登记方式并根据患者流向作出战略转型,卫生行政部门应了解县域内住院率的影响因素以科学决策。
Objective:To analyze the conception,variable choosing and data accessibility of inside-county medical utilization rate,provide a unified index for evaluating hierarchical medical utilization,and provide a policy reference.Methods:It confirmed the data resource,analyzed the meaning and rightness of out-patient and hospitalization rate,analyzed the meaning and data source of permanent resident population,registered population and insured population.Results:Calculating the inside-county medical utilization rate from the provider side is difficult,with high cost and low accuracy.Medical insurance side would provide more convenient and precise services;inside-county hospitalization rate was better than out-patient rate,because outpatient rates is distorted easily.Conclusion:Inside-county hospitalization rate should be used as the key index of evaluating hierarchical medical utilization,hospitals union in county should improve the home page of medical record and make strategy transformation according to the pattern patients flows,management department should take into account the influencing factor of inside-county medical utilization rate for making rational decisions.
作者
郑芸
农圣
黄二丹
马柠
ZHENG Yun;NONG Sheng;HUANG Er-da(Youjiang Medical University for Nationalities,Baise,Guangxi,533000,China;不详)
出处
《中国卫生经济》
北大核心
2020年第8期58-61,共4页
Chinese Health Economics
基金
国家自然科学基金项目(71563056)。
关键词
县域
就诊率
分级诊疗
变量选择
inside-county
medical utilization rate
hierarchical diagnosis
variable choosing
