城乡居民医保社区门诊统筹对提高基层医疗服务利用的效果研究

Effect of Pooling Funds of Outpatient Service in Medical Insurance on Increasing Utilization of Primary Health Care Services for Community Residents

目的总结长沙市城乡居民医保社区门诊统筹的主要做法和经验，并通过实证分析评价门诊统筹的实施成效。方法于2011年采取整群抽样的方法抽取了长沙市已开展门诊统筹的10家社区卫生服务机构和未开展门诊统筹的9家社区卫生服务机构进行调查；在开展调查的社区卫生服务机构中，再分别随机抽取3家已开展门诊统筹的社区和3家未参加门诊统筹的社区，在每个社区中各随机抽取城镇居民100名，共计600名，进行基层卫生服务利用情况的调查，并对比分析医保社区门诊统筹对提高居民基层医疗服务利用率的效果。结果开展医保门诊统筹的社区卫生服务机构月平均门诊统筹就诊人次数、慢性病管理率均逐月上升。已开展门诊统筹的社区卫生服务机构的健康档案建档率均在80％左右，辖区居民两周就诊率为213．6％e，且有91．1％的居民首选在社区就诊，均明显高于未开展门诊统筹的社区；居民对社区卫生服务机构基本药品供应状况、社区医疗设备、药物价格、医护人员的技术水平、医务人员的服务态度等方面的满意度及总体满意度也均明显高于未开展门诊统筹的社区，差异有统计学意义（P〈0．05）。结论通过门诊统筹的试点，促进了居民对基层医疗服务机构的选择，形成了小病进社区、大病进医院的合理分流；同时，门诊统筹工作的开展在确保基层医疗服务质量、提高居民对基层医疗服务的利用率、促进基层医疗服务机构的发展方面均取得了显著的成效。

Objective To summarize the practices and experience of the pooling funds of outpatient service in medical insurance for urban and rural community residents, and evaluate the effect of implementing the pooling funds. Methods The duster sampling was taken in 2011 to choose in Changsha city 10 community health service organizations where pooling funds for outpatient service had been carried out and 9 organizations where the pooling funds had not been carried out, and for each kind of organizations 3 were randomly chosen and then from each organization 100 residents were randomly chosen, totally 600 community residents were recruited. Among them the investigation was conducted about the utilization of primary medical services so as to e- valuate the effect of implementing the pooling funds. Results In the organizations where the pooling funds of outpatient service in medical insurance the average person - times of visit per month and chronic disease management rate went up monthly; the fil- ing rate of health record was more than 80%, the residents＇ visiting rate in two weeks was 213.6%~, and 91.1% of them took the community health service as their first choice. All the conditions were better as compared with those in the organizations where the pooling funds had not been carried out. The residents＇ total satisfaction and dimensional satisfactions on supply of essential drugs, medical equipment, drug price, skills of medical staff, and attitude of staff＇s service were remarkably higher as compared with in the organizations where the pooling funds had not been carried out （P 〈 0.05 ）. Conclusion The implementation of pooling funds of outpatient service promotes the residents＇ choice of primary health services organization, and thus ensure reasonable shunt for milder diseases handled in community and severer disease in hospital. At the same time, in can ensure the service quality of primary health care, increase its utilization rate, and promote its development.