| 引用本文：张皓, 刘悦, 顾淑燕, 甄雪梅, 曾玉航, 顾钰璇, 董恒进.分级诊疗能节省成本吗?——基于系统动力学模型的浙江省诊疗系统分级优化成本测算[J].中国卫生政策研究,2017,10(7):13-21 |
|
| 分级诊疗能节省成本吗?——基于系统动力学模型的浙江省诊疗系统分级优化成本测算 |
| 投稿时间：2017-02-15 修订日期：2017-06-25 PDF全文浏览 HTML全文浏览 |
| 张皓1,2, 刘悦1, 顾淑燕1, 甄雪梅1, 曾玉航1, 顾钰璇1, 董恒进1,3 |
1. 浙江大学医学院公共卫生系卫生政策学研究中心 浙江杭州 310058;
2. 杭州师范大学 浙江杭州 311121;
3. 上海交通大学中国医院发展研究院 上海 200240 |
| 摘要:虽然多国的经验证明了分级诊疗能够有效配置、利用卫生资源，但中国目前由于无序就医造成资源的浪费尚无精确估计。逐步建立健全分级诊疗制度成为中国新医改的重要发展方向，因此有必要对改革可能带来的效益进行估算。本研究以浙江省为例，采用系统动力学方法仿真诊疗系统模型，以不同的分级优化模式为情境对系统进行分级优化，分析成本节约情况。结果显示，如果基层首诊率在目前的水平上增加10%，直接医疗成本将节约2.51亿，如果基层首诊增加15%，直接医疗成本将节约3.9亿。如果基层首诊率达最高意愿水平（72.35%），县域内就达到分级诊疗改革阶段性目标（90%），那么三级医院门诊量将减少0.13亿人次，基层医疗卫生服务机构增加0.74亿人次，节约直接医疗成本30.16亿元。 |
| 关键词:分级诊疗体系 系统动力学 医疗成本 |
| 基金项目:国家自然科学基金项目（71573229）；浙江省医药卫生科技计划（2014KYA055）；浙江省自然科学基金项目（LQ14G030009） |
|
| Whether tiered medical care system is effective in saving costs?Cost savings estimation of the medical care system after tiered optimization in Zhejiang Province based on system dynamics model |
| ZHANG Hao1,2, LIU Yue1, GU Shu-yan1, ZHEN Xue-mei1, ZENG Yu-hang1, GU Yu-xuan1, DONG Heng-jin1,3 |
1. Center for Health Policy Studies, Department of Public Health, Zhejiang University School of Medicine, Hangzhou Zhejiang 310058, China;
2. Hangzhou Normal University, Hangzhou Zhejiang 311121, China;
3. Shanghai Jiaotong University National Institute Hospital Developement, Shanghai 200240, China |
| Abstract:The experience of various countries proves that the hierarchical diagnosis and treatment model can lead to reasonable resources allocation and utilization, however, the waste of China's disordered treatment model has not been estimated. Nowadays, it is very important to establish a hierarchical diagnosis and treatment system during China's healthcare system reform. Therefore, it is necessary to estimate the benefit the reform may bring. We take Zhejiang Province as an example, and adopted the system dynamics model to build the health delivery system, to emulate the hierarchical diagnosis and treatment model and the disordered model, and to evaluate the benefit. Results showed that if first option at the primary health institutions increased 10%, it could save 0.251 billion yuan, and if increased 15%, it could save 0.39 billion yuan. If the first option at the primary health institution reached 72.35% and the treatment in county reached 90%, the outpatient in tertiary hospital could reduce by 13 million, and those in primary healthcare institutions could increase by 74 million yuan. The direct healthcare cost could reduce 3.016 billion Yuan. |
| Key words:Hierarchical diagnosis and treatment system System dynamics Healthcare cost |
| 摘要点击次数: 2137 全文下载次数: 18 |
|
|
|
|
|
