医保综合支付方式改革引导医疗行为改变的实证分析

发布时间：2018-06-06 15:46

本文选题：医保支付方式改革 + 医疗费用控制　；参考：《中国卫生经济》2017年05期

【摘要】：目的:对比平谷区新型农村合作医疗葡萄相关指标,评估平谷区新型农村合作医疗综合支付方式改革引导医疗行为改变的效果。方法:对平谷区医院相关DRGs指标以及基层住院和试点乡镇门诊相关数据进行比较。结果:急症短期住院费用增长得到控制、药占比等下降;基层医疗机构不必要住院大幅降低、基层门诊回流。结论:北京市平谷区采用急症短期住院按诊断相关组(DRGs)、慢病长期住院按床日和与签约服务相结合的门诊按人头付费的新型农村合作医疗综合支付方式改革试点数据显示,医院工作效率提高并可获得相应控费激励性收益,体现了医保支付方式有效引导医疗行为的效果。
[Abstract]:Objective: to evaluate the effect of comprehensive payment reform of new rural cooperative medical care (NCMS) in Pinggu district on the change of medical behavior by comparing the related indexes of grape in New Rural Cooperative Medical system (NCMS) in Pinggu District. Methods: the relevant DRGs indexes of Pinggu district hospital and the related data of primary hospitalization and pilot township outpatient service were compared. Results: the increase of hospital expenses was controlled, the proportion of drugs decreased, the unnecessary hospitalization in primary medical institutions decreased significantly, and the reflux of primary outpatient service. Conclusion: in Pinggu district of Beijing, the new rural cooperative medical service comprehensive payment mode reform, which is based on emergency and short-term hospitalization according to diagnosis related group, slow disease long-term hospitalization according to bed day and outpatient service combined with contract service, is a new type of rural cooperative medical treatment comprehensive payment mode reform. The efficiency of hospital work is improved and the incentive income can be obtained, which reflects the effect of medical insurance payment mode to guide medical behavior.
【作者单位】：北京市新型农村合作医疗服务管理中心;首都医科大学附属北京安贞医院;北京市公共卫生信息中心;北京市平谷区农村合作医疗管理中心;北京市卫生和计划生育委员会;
【分类号】：F842.684;R197.1

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