引用本文:朱坤,张小娟,毛瑛.陕西省新农合单病种定额付费改革的效果分析 ——基于镇安和旬邑两县的抽样调查[J].中国卫生政策研究,2013,6(6):16-22 |
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陕西省新农合单病种定额付费改革的效果分析 ——基于镇安和旬邑两县的抽样调查 |
投稿时间:2013-04-18 修订日期:2013-06-08 PDF全文浏览 HTML全文浏览 |
朱坤1, 张小娟1, 毛瑛2 |
1.中国医学科学院医学信息研究所/卫生政策与管理研究中心;2.西安交通大学公共政策与管理学院 |
摘要:目的:实证分析陕西省单病种定额付费改革的实施效果。方法:选择陕西省镇安和旬邑两县作为研究对象。资料主要包括两县2008—2011年的新农合报表;同时对两县164名县级医院医务人员进行调查,了解他们对单病种定额付费的认知。定性资料主要采用焦点组访谈和个人深入访谈的方法,共访谈32人。利用SPSS13.0和EXCEL2007等软件进行数据分析。结果:单病种定额付费改革后医疗机构次均住院费用增速减缓,对医疗服务质量的影响尚不确定,对医务人员的满意度产生一定影响,提高了参合农民住院医疗服务的可及性,有助于引导患者合理就医,促进卫生资源有效利用;实施单病种定额付费患者的疾病负担缓解程度更加明显,也有助于降低新农合基金的风险。建议:科学制定支付标准,为顺利实施单病种定额付费改革奠定基础;建立健全针对供方的有效激励约束机制;加强单病种定额付费对医疗服务质量影响的研究和对定点医疗机构的监管。 |
关键词:新型农村合作医疗 单病种付费 可及性 医疗费用 医疗质量 |
基金项目:中澳卫生与艾滋病项目“医药卫生体制改革评价研究” |
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Analysis of the effect of case based payment in Shaanxi Province: Based on the investigation in Zhenan and Xunyi counties |
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Abstract:Objective: To analyze the effect of case based payment empirically in Shaanxi province. Methods: Zhenan county and Xunyi county were selected as sample counties. New Rural Cooperative Medical Scheme (NRCMS) operational data was collected from 2008 to 2011. 164 doctors from two county hospitals were selected to fill the questionnaire on recognition of case based payment. Qualitative data were collected with in depth review and focus group discussion and 32 presidents of hospital, directors of local health bureau, directors of NRCMS office as qualitative survey. SPSS13.0, EXCEL2007 were selected as tools to analyze collected data. Results: Average hospitalization expenditure growth slowed down after adoption of case based payment; the impact of case based payment on medical quality was still obscure; case based payment affected satisfaction of doctors to some extent. After adoption of case based payment, rural residents access to inpatient service was improved; health resources in county were made use of more fully; and the burden of diseases of the rural residents covered by case based payment were alleviated more significantly. The risk of pooling fund for NRCMS were lowered with the adoption of case based payment. Suggestions: setting up standards of payment for the cases selected scientifically; setting up and perfecting effective incentive mechanism for providers; studying on the impact of case based payment on medical quality further; strengthening the supervision on providers. |
Key words:New Rural Cooperative Medical Scheme Case based payment Access |
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