| 引用本文：钟正东, 杨孝灯, 吴德武, 吴锡豪, 林坤河, 刘宵, 周津, 熊英贝, 项莉.三明市医共体支付方式改革的协同治理模式及效果分析——以尤溪县总医院为例[J].中国卫生政策研究,2022,15(3):1-8 |
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| 三明市医共体支付方式改革的协同治理模式及效果分析——以尤溪县总医院为例 |
| 投稿时间：2022-02-08 修订日期：2022-02-28 PDF全文浏览 HTML全文浏览 |
| 钟正东1, 杨孝灯2, 吴德武2, 吴锡豪2, 林坤河1, 刘宵1, 周津1, 熊英贝1, 项莉1 |
1. 国家医疗保障研究院华科基地 华中科技大学医药卫生管理学院 湖北武汉 430000;
2. 尤溪县总医院 福建三明 365100 |
| 摘要:目的：系统梳理三明市医共体支付方式改革的协同治理模式，以尤溪县总医院为例分析改革效果。方法：基于协同治理理论，采用主题分析法分析定性资料。采用描述性分析、间断时间序列分析分别评价尤溪县总医院支付方式改革年度数据、月度数据。结果：支付方式改革多元治理主体间、改革政策间存在协同机制。改革后，尤溪县医保基金结余率提高至2.84%，医共体牵头医院的门急诊人次、住院人次、手术人次上升趋势明显减缓，基层医疗卫生机构的诊疗人次数占比从50.8%提高至68.5%，高血压、糖尿病、重性精神障碍的公共卫生管理指标均呈现上升趋势，城乡居民医保患者出院次均自付费用降幅达20.1%。结论：政府主导促进了治理主体间协同，多元治理主体间协同促进改革政策协同，明确、协同的改革政策促进医共体、管理者、医务人员的服务行为从以治疗为中心转向以健康为中心，改革具有可持续性。 |
| 关键词:三明市医改 医共体 支付方式 协同治理 |
| 基金项目:国家自然科学基金(71874058,72174068) |
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| Collaborative governance model and effect analysis of the reform of county medical alliance payment method in Sanming:Taking Youxi General Hospital as an example |
| ZHONG Zheng-dong1, YANG Xiao-deng2, WU De-wu2, WU Xi-hao2, LIN Kun-he1, LIU Xiao1, ZHOU Jin1, XIONG Ying-bei1, XIANG Li1 |
1. HUST Base of National Institute of Healthcare Security, School of Medicine and Health Management, Huazhong University of Science & Technology, Wuhan Hubei 430000, China;
2. Youxi General Hospital, Sanming Fujian 365100, China |
| Abstract:Objective: To systematically sort out the collaborative governance model of the reform of the county medical alliance payment method in Sanming, and analyze the reform effect by taking Youxi General Hospital as an example.Methods:Qualitative data were analyzed by thematic analysis method based on the theory of collaborative governance. Descriptive analysis and interrupted time-series analysis were used to evaluate the annual data and monthly data of Youxi General Hospital's payment method reform.Results: There is a synergy mechanism among the multiple governance subjects and the reform policies in the payment method reform. The balance rate of medical insurance funds in Youxi has increased to 2.84% after the reform.The rising trend of outpatient and emergency visits, inpatient visits, and surgeries in the leading hospitals of the county medical alliance has slowed down significantly.The proportion of visits in primary hospitals increased to 69.2%.The public health management indicators of hypertension, diabetes, and severe mental disorders all showed an upward trend.The out-of-pocket expenses of urban and rural residents' medical insurance patients on discharge dropped by 20.1%. Conclusions: The municipal party committee and the municipal government take the lead to promote the coordination among governance subjects, and the coordination among multiple governance subjects promotes the coordination of reform policies. A clear and coordinated reform policy promotes the service behavior of the county medical alliance, managers and medical staff from treatment-centered to health-centered, so the reform becomes sustainable. |
| Key words:Sanming healthcare system reform County medical alliance Payment method Collaborative governance |
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