引用本文:姚轶凡, 林坤河, 钟正东, 项莉.医保按人头付费对医共体慢病管理的治理机制研究——基于整体性治理视角[J].中国卫生政策研究,2023,16(3):30-36 |
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医保按人头付费对医共体慢病管理的治理机制研究——基于整体性治理视角 |
投稿时间:2022-11-02 修订日期:2023-02-22 PDF全文浏览 HTML全文浏览 |
姚轶凡, 林坤河, 钟正东, 项莉 |
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 430030 |
摘要:目的:探索医保按人头付费对典型地区医共体慢病管理的治理机制,为提升治理效果提出相关建议。方法:收集三个医共体2017—2019年慢病管理数据进行描述性分析。并进行χ2检验;基于整体性治理理论,采用主题分析法分析按人头付费对不同地区医共体慢病管理的治理实践。结果:医共体医保支付方式改革后,A地高血压和糖尿病两病控制率和规范管理率均得到显著提升;B地两病规范管理率小幅下降,两病控制率均先上升后下降;C地高血压规范管理率总体呈下降趋势,糖尿病规范管理率先下降后上升,两病控制率有上升趋势,以上结果均有统计学意义(P<0.05)。结论:在整体性治理下医保按人头付费能有效提升医共体慢病管理治理效果,但也会因为医共体治理理念和行为的差异,形成不同程度的激励机制和整合机制,导致按人头付费在不同治理机制下对医共体慢病管理产生不同治理效果。 |
关键词:医共体 按人头付费 整体性治理 慢病管理 |
基金项目:国家自然科学基金(71874058;72174068) |
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Research on the governance mechanism of capitation for chronic diseases management in medical community: Based on the perspective of holistic governance |
YAO Yi-fan, LIN Kun-he, ZHONG Zheng-dong, XIANG Li |
HUST Base of National Institute of Healthcare Security, School of Medicine Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei 430030, China |
Abstract:Objective: To explore the governance mechanism of capitation for chronic diseases management in typical medical communities, and put forward relevant suggestions for improving the governance effect. Methods: This study collect the chronic disease management data of three medical communities from 2017 to 2019 for descriptive analysis, and the differences of indicators were analyzed by chi-square test. Based on the holistic governance theory, the theme analysis method is used to analyze the governance practice of the medical community's capitation based management of chronic diseases in different regions. Results: The control rate and management rate of hypertension and diabetes were significantly improved after the reform of the medical insurance payment mode in A medical community; The management rate of hypertension and diabetes in B region decreased slightly, and the control rate of hypertension and diabetes both increased first and then decreased; The management rate of hypertension in C region generally showed a downward trend, the management of diabetes took the lead in declining and then rose, and the control rate of hypertension and diabetes showed an upward trend, all the results were statistically significant (P<0.05). Conclusion: The capitation of medical insurance can effectively improve the management effect of chronic diseases under the holistic governance of the medical community, but it will also lead to different levels of incentive mechanism and integration mechanism due to the differences in the governance concepts and governance behaviors of the medical community, resulting in different governance effects of capitation on the management of chronic diseases of different governance mechanisms' medical communities. |
Key words:Medical community Capitation Holistic governance Chronic disease management |
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