社区卫生服务中心医养结合服务的补偿现况分析

Analysis of the Current Situation of Compensation Mechanism of the Combination of Medical and Health Services in Community Health Service Centers

目的基于社区服务量的基础上,探索75项医养结合服务项目的补偿分类和补偿方式,剖析存在的问题,以为社区医养结合工作的有序开展提供指导。方法通过项目组会议、研讨会等方法厘清不同医养结合项目的补偿情况分类,以及采集2015—2017年度各服务项目服务数量,再基于年平均服务量的基础,分析各医养结合服务项目当前的补偿额度与成本间的差异,探索不同类别的医养结合服务项目所需的财政补偿方式和办法。结果75项医养结合服务中,基本医疗类服务目前有财政补偿、医保预付和自费三种补偿方式;基本公共卫生类的服务目前有财政补偿和国家公共卫生经费补贴55元/年/人,仍远无法覆盖成本392256.0~669955.3元/年,还需补偿差额374106.0~651805.3元/年;非双基服务目前无任何补偿措施,预计需补偿767579.8~926834.9元/年。结论我国政府要加大社区卫生服务的投入力度,提高补偿标准,同时可从长期护理保险等方面完善补偿机制,从而提高医养结合服务的水平和效率,维持社区医养结合服务的长效运行。

Objective Based on the amount of community service,to explore the compensation classification and compensation methods of 75 medical-integrated service projects,analyze the existing problems,and provide guidance for the orderly development of community medical care.Methods Through project team meetings,seminars and other methods to clarify the classification of compensation for different combination of medical and health services projects,and collect the number of services for each service project in 2015-2017,and then analyze the current medical care combined services based on the annual average service volume.The difference between the compensation quota and the cost,and explore the financial compensation methods and methods required for different types of medical integration services.Results Among the 75 medical combined services,the basic medical services are currently prepaid by medical insurance;the basic public health services currently only have a state subsidy of 55 yuan/year/person,far from covering the cost of 392256.0~669955.3 yuan per year,and the compensation difference is 374106.0~651805.3 yuan per year;non-double-based services currently do not have any compensation measures,and it is expected to be compensated for 767579.8~926834.9 yuan per year.Conclusion The Chinese government should increase the investment in community health services,improve the compensation standards,and improve the compensation mechanism from the aspects of long-term care insurance,develop the level and efficiency of the combination of medical care and maintenance,and maintain the long-term operation of community health care combined services.