政府与非政府举办社区卫生服务中心医保纳入及实施效果比较分析

A comparative analysis on implementation and effect of medical insurance among governmental and non-governmental community health service centers

目的:比较政府与非政府举办社区卫生服务中心的医保纳入情况和实施效果。方法:利用社区卫生服务全国重点联系城市的数据,采用卡方、非参数检验进行统计学分析。结果:(1)政府和非政府举办的社区卫生服务中心医保定点比例分别为95.72%和94.58%;(2)政府举办的社区卫生服务中心服务提供效率高于非政府举办的,医保定点社区卫生服务中心服务提供和利用效率均高于非医保定点;(3)医保定点社区卫生服务中心业务收入高于非医保定点,非政府举办的医保定点社区卫生服务中心医保收入占业务收入比例高于政府举办的;(4)医保定点社区卫生服务中心的平均门诊费用高于非医保定点的社区卫生服务中心。结论与建议:医保政策和调控机制已对社区卫生服务中心效用发挥积极的作用,但制度建设仍有发展空间;政府举办具有一定优势,应进一步加强政府主导作用。

Objectives：To compare the differences of implementation and effect of health insurance among governmental and non-governmental community health service centers（CHCs）.Methods：Using data of the community health service of national key contact city,applying chi-square test and non-parametric test to conduct the statistical analysis.Results：（1） The proportions of governmental and non-governmental CHCs covered by medical insurance were 95.72% and 94.58 % respectively.（2） The service provision efficiency of governmental CHCs was higher than the non-governmental ones,the service provision and service utilization efficiency among CHCs covered by medical insurance was better than those covered.（3）The business revenue among CHCs covered by medical insurance were higher than those not covered,the proportion of medical insurance revenue in business revenue of non-governmental CHCs was higher than the governmental ones.（4） For the centers covered by medical insurance,the average outpatient expenses ware higher than those not covered.Conclusions and recommendations：Medical insurance policy and regulative mechanism have had positive influence on the utilization of CHCs,but there was some space to improve;the governmental CHCs have more advantages,so the leading role of the governmental should be strengthened.