城市医疗救助资金利用及定点机构运行状况调查研究——基于西宁、银川两项目市的实地考察

The Survey on Capital Utilization of Urban Medical Assistance and Operation Status of Appointed Service Institution——Based on the Field Review of Xi’ning and Yinchuan Project City

目的了解UHPP西宁、银川两试点市医疗救助资金的利用情况、定点医疗救助服务机构的运行现状及社区医生的诊疗行为。方法项目常规资料的收集;对项目(救助)办、民政、社保和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。结果两项目地区医疗救助资金使用率维持在65%左右,呈现救助资金筹集的绝对不足与相对过剩;医疗救助定点机构的服务功能和模式得到一定转变,业务量和经营收入有明显提升,但双向转诊落实不力,药品收入所占比例较高。结论优化方案设计和规避救助资源浪费,提高医疗救助资金的使用效益;应将城市社区卫生服务体系与医疗救助制度有机地结合起来,同时注重进一步控制和规范社区医生的处方行为。

OBJECTIVE To understand the utilization of medical assistance fund, the operation status on appointed service institution and clinic conducts of community doctors in Xi’ning and Yinchuan City. METHODS The collection of routine data, individual depth interview with the managers from the project office and different departments; investgating four appointed service institutions through the questionnaire and selecting randomly eight hundred prescriptions on assistance and non-assistance object. RESULTS The utilization rates of medical assistance fund in the two regions are maintained around senvety percents. The function and model of service supply of appointed institutions is transferred to some extend. The portfolios and management income of appointed institutions are advanced obviously with high medicine incomes. CONCLUSION We should optimize programme design and avoid the waste of assistance resources to improve the utilization benefit of medical assistance fund, harmoniously combine urban community health service system and medical assistance system.