整合服务改革中基于绩效的集团总额预付模式探索及效果

发布时间：2018-09-06 10:13

【摘要】：目的:探索适宜我国区域医疗服务体系改革的混合预付支付模式,并论证其效果。方法:借鉴国内外医疗集团支付模式,设计以"按疾病测算+集团打包预付+单病种付费+绩效管理"为核心的集团总额预付制,并通过准实验的政策干预对照试验,利用差分模型,论证该支付方式在控费和改善服务协作方面的效果。结果:从4个乡镇中筛选符合病种纳入标准的住院报销样本共38 980条,以及两级住院病历共194份,发现相对对照组,实验组每人每5个月平均住院率下降0.08%,三级医院住院服务风险比下降0.16%,服务连续性上升了33.80%。集团总额预付制有助于降低住院结构、促进医疗协作,但实际效果因基层首诊和双向转诊制度未能很好执行受到一定影响。结论:建议未来医联体改革应以激励医疗协作、改善服务质量为目标,以分级诊疗和信息共享为基础,在循证基础上配合实施适宜的混合预付模式。
[Abstract]:Objective: to explore a mixed prepayment model suitable for the reform of regional medical service system in China and to demonstrate its effect. Methods: drawing lessons from the payment mode of medical group at home and abroad, the group total advance system was designed, which was based on the performance management of prepackaged prepaid payment for single disease category according to the disease measurement group, and the policy intervention control trial was carried out through quasi-experimental policy intervention. The difference model is used to demonstrate the effectiveness of the method in controlling fees and improving service collaboration. Results: a total of 38,980 inpatient reimbursement samples were selected from 4 villages and towns, and 194 medical records were collected from two levels of hospitalization. In the experimental group, the average hospitalization rate per person every 5 months decreased by 0.08%, the risk ratio of hospital service in the tertiary hospital decreased by 0.16%, and the service continuity increased by 33.80%. The group total advance system is helpful to reduce the hospital structure and promote medical cooperation, but the actual effect is affected by the failure of the primary diagnosis and two-way referral system. Conclusion: it is suggested that the future reform should be aimed at encouraging medical cooperation and improving service quality, based on classified diagnosis and information sharing, and on the basis of evidence based on the implementation of appropriate mixed prepaid model.
【作者单位】：中国药科大学国际医药商学院;华中科技大学同济医学院医药卫生管理学院;湖北农村健康服务研究中心;
【基金】：中华医学基金会资助项目(11-069) 国家自然科学基金青年项目(71603278)
【分类号】：R197.1

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