人头包干付费在住院分娩中的运用效果分析

Outcome analysis of capitation payment as used in hospital delivery

目的研究银川市职工生育保险按人头包干付费方式对产科有关指标的影响。方法收集2011年至2012年实施按人头包干付费后银川市部分定点医院产科住院产妇的有关指标，如剖宫产率、诊疗费用、药品费用及平均住院日等，并将孕产妇、新生儿死亡率作为医疗质量的监测指标。结果实施人头包干付费政策后，参保职工的剖宫产率、次均住院费用、次均药品费用、平均住院日均有所降低，次均住院费用降幅近10％，次均药品费用降幅在45％左右。孕产妇和新生儿死亡率差异无统计学意义。结论实施人头包干付费方式，有利于降低剖宫产率，降低医疗费用，节约医保资金，提高卫生资源的使用效率。

Objective To study the impact of capitation payment on obstetric indicators for the maternity insurance of urban workers in Yinchuan eity. Methods Collection of indicators on lying-in women hospitalized at the obstetrics departments of designated hospitals in Yinchuan, in the period of 2011 to 2012 when the capitation payment was put in place. Such indicators include the percentage of uterine-incision delivery, diagnostics and therapeutic expenses, drug expenses, and average days of stay, along with mortality of pregnant and lying-in women and that of newborns, which are used as indicators to measure quality of care. Results The capitation payment policy has witnessed drops in the percentage of uterine-incision delivery, cost per inpatient, drug expenses per inpatient and average days of stay among urban workers covered by the insurance. The drops amount to 10% for cost per inpatient and 45% for drug expenses per inpatient. The differences found in pregnant and lying-in women are not statistically significant. Conclusion Capitation payment is conducive to dropping the percentage of uterine-incision delivery and medical expenses, and saving medical insurance payment, for the sake of optimal use of healthcare resources.