基于社区卫生服务的城市医疗救助费用控制模式的情景分析

Scenario Analysis of the Cost Control Model of Urban Medical Assistance Based on Community Health Services

目的识别影响城市医疗救助费用控制的关键事件,为其进一步可持续发展提供依据。方法项目常规资料的收集;对项目(救助)办、民政、社保、卫生等部门管理人员及社区卫生服务机构人员的访谈;自制问卷调查了4家定点医疗救助服务机构,并从中随机抽取医疗救助对象和非救助对象处方共800张。结果利用情景分析的方法,识别了影响目前城市医疗救助费用控制发展的5个关键事件:医疗救助资金的筹集、救助对象的确定、社区卫生服务机构的发展、支付方式的设置、多部门协调支持机制的建立与合作。结论构建乐观情景、无突变情景和悲观情景3种情景,根据关键事件的解决程度其中以无突变情景发生的可能性最大。

Objective To identify key events that affect the cost control of the urban medical assistance,and to provide basis for the sustainable development.Methods Indepth-interview was used for information collection in this study.The officers from project office,civil administration,social insurance and health departments and health workers from community health service were interviewed.Four appointed medical institutions were investigated by using self-made questionnaire and eight hundred prescriptions of assistance and non-assistance objects from four institutions were selected randomly.Results Using the method of scenario analysis to identify 5 key events: the raise of medical assistance funds,the identification of assistance objects,the development of community health service,the payment settings and the establishment and cooperation of multi-sector coordination.Conclusion The paper constructed 3 scenarios of future development including scenarios of optimism,no sudden change and pessimism,and the probability of the scenario of no sudden change is the most according to the resolve of key events.