| 引用本文：熊英贝, 钟正东, 林坤河, 刘宵, 周津, 项莉.三明市医共体内外经济激励对医疗服务供给的影响研究[J].中国卫生政策研究,2022,15(7):66-73 |
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| 三明市医共体内外经济激励对医疗服务供给的影响研究 |
| 投稿时间：2022-05-04 修订日期：2022-07-08 PDF全文浏览 HTML全文浏览 |
| 熊英贝, 钟正东, 林坤河, 刘宵, 周津, 项莉 |
| 国家医疗保障研究院华科基地 华中科技大学同济医学院医药卫生管理学院 湖北武汉 430030 |
| 摘要:目的：了解三明市内部年薪工分制改革与外部医共体打包支付及其他一系列配套政策改革下医疗服务供给的变化情况，以及内外部经济激励政策的协同影响机制。方法：以三明市2015年8月年薪工分制改革、2018年1月医共体打包支付改革为政策干预时点，采用间断时间序列（ITSA）分段回归模型对3个政策时段月度数据的变化情况进行分析。结果：年薪工分制实施后，全市及基层门急诊人次均较改革前有大幅提升，医院门急诊人次仍保持既往上涨趋势。医共体打包支付实施后，全市、基层、医院门急诊及入院人次的上升趋势均明显减缓，基层门急诊人次占比增长速度明显下降。结论：发挥外部经济激励的宏观调控作用，能够规范由不合理内部经济激励引起的过度医疗服务供给行为；内部与外部经济激励联动改革，才能顺利推进分级诊疗制度的实施。 |
| 关键词:三明医改|县域医共体|支付方式|薪酬制度|医疗服务供给 |
| 基金项目:国家自然科学基金（71874058，72174068）；中央高校基本科研业务费（YCJJ202204018） |
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| Research on the influence of internal and external economic incentives of Sanming county medical alliance on medical service supply |
| XIONG Ying-bei, ZHONG Zheng-dong, LIN Kun-he, LIU Xiao, ZHOU Jin, XIANG Li |
| HUST Base of National Institute of Healthcare Security, School of Medicine Health Management of Tongji Medical college of Huazhong University of Science and Technology, Wuhan Hubei 430030, China |
| Abstract:Objective: To explore the changes of medical service supply in Sanming under the internal annual salary point system reform, the external county medical alliance package payment reform and a series of other supporting policies, and the synergistic influence mechanism of internal and external economic incentive policies.Methods: Taking Sanming's annual salary point system reform in August 2015, and the package payment reform of county medical alliance in January 2018 as the policy intervention points.The monthly data changes in the three policy periods were analyzed by using the interrupted time series (ITSA) regression model.Results: After the implementation of the annual salary point system, the outpatient and emergency visits of the whole city and grassroots hospitals were significantly increased, and the outpatient and emergency visits of the hospital still kept the upward trend.After the implementation of package payment reform of county medical alliance, the upward trend of outpatient and emergency visits and inpatients in the whole city, grassroots hospitals and hospitals slowed down significantly, and the growth rate of the proportion of outpatient and emergency visits in grassroots hospitals declined significantly.Conclusion: Exerting the macro-control function of external economic incentives can regulate the behavior of excessive medical service supply caused by unreasonable internal economic incentives.Only coordinated reform with internal and external economic incentives can smoothly promote the implementation of hierarchical medical system. |
| Key words:Sanming medical reform|County medical alliance|Payment method|Salary system|Medical service supply |
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