| 引用本文：胡敏, Winnie C-M Yip, 陈文, 祝菁菁.如何提高农村基层医疗服务的效率和质量——宁夏新农合门诊按人头预付制改革设计与效果[J].中国卫生政策研究,2014,7(8):14-18 |
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| 如何提高农村基层医疗服务的效率和质量——宁夏新农合门诊按人头预付制改革设计与效果 |
| 投稿时间：2014-06-25 修订日期：2014-07-23 PDF全文浏览 HTML全文浏览 |
| 胡敏1, Winnie C-M Yip2, 陈文1, 祝菁菁1 |
1. 复旦大学公共卫生学院 上海 200032;
2. 牛津大学布拉瓦尼克政府学院 英国牛津 OX1 4JJ |
| 摘要:本研究以宁夏回族自治区为案例，针对村医经济激励水平低下，按项目付费引发不恰当诊治行为，系统内缺乏引导供方提高自身服务效率和质量并促进服务与体系整合协调的经济激励等问题，从供方合理激励的角度出发，对新型农村合作医疗支付制度进行改革设计——以乡村为整体对乡镇卫生院和村卫生室提供的门诊服务实施基于绩效的按人头预付制。随后利用配对整群随机试验设计对改革效果进行评估和检验。研究发现，这一支付制度的实施有效降低了农村基本医疗服务中抗生素的使用率，优化了供方的处方行为，对降低村卫生室的单次门诊费用有一定作用，并且促进服务向村卫生室下沉。本文的政策分析和设计思路及严格的政策评估结果可以为我国支付制度的选择和发展提供政策参考和证据支持。 |
| 关键词:按人头预付 按绩效支付 效率 质量 整合服务 |
| 基金项目:盖茨基金会项目（OPPGH5252）；国家社会科学基金重大项目（11&ZD176） |
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| How to improve the efficiency and quality of basic healthcare：Design and outcomes of capitation with pay-for-performance payment system reform in Ningxia |
| HU Min1, Winnie C-M Yip2, CHEN Wen1, ZHU Jing-jing1 |
1. School of Public Health, Fudan University, Shanghai 200032, China;
2. Blavatnik School of Government, University of Oxford, Oxford OX1 4JJ, UK |
| Abstract:For the issues of low-power incentives for village physicians (VP), perverse incentives incurred by fee-for-service plans and the lack of incentives to improve efficiency or quality as well as to encourage township healthcare centers (THC) to perform their role in managing village doctors and referrals, the study designed an overall capitation with pay-for-performance payment system in the Ningxia Hui Autonomous Region to cover outpatient services at THCs and all VPs under its supervision to rebuild the incentive mechanisms for the supply side. With the matched-pair cluster-randomized experiment study design, this article found that payment intervention led to a reduction in antibiotic prescriptions which improved drug prescribing practices and a small reduction in total expenditure per visit in village clinics. The results also showed that VPs undertook more volumes than THCs did. Both the proposed policy framework and rigorous impact evaluation will shed light on future provider payment system developments. |
| Key words:Capitation Pay-for-performance Efficiency Quality Integrated services |
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