新农合重大疾病定点医疗机构确定原则探讨

Principals of selecting designated hospitals for inpatients of NRCMS with critical illness

目的探讨如何科学合理地确定重大疾病定点医疗机构。方法利用广西某县新农合2009年至2011年的大病患者住院数据，分析患者的就诊流向，并结合卫生政策分析的一般原则对现有政策进行分析。结果影响患者就诊流向的因素有多种，仅依靠技术水平来确定定点医院具有一定的局限性，不能充分体现政策的公平、效率、质量、稳定性和可持续性。结论无论是可以根治对医疗技术水平依赖较高的第一类需求，还是需反复住院不过多依赖于医疗技术水平的第二类需求，都符合成本效益最大化原则。重大疾病定点医疗机构的合理确定不能仅取决于医院是否具有相应的医疗技术水平，还应根据患者的合理医疗需求科学、合理的确定。

Objective To explore how to determine the designated hospitals for critical illness scientifically and reasonably. Methods Analyzing the choice of medical providers by inpatients with critical illness, by means of the database of NRCMS in 2009-2010 in one county, Guangxi province. And analyzing the current policies on the basis of general principals used in health policy analysis. Results The choices of medical providers made by inpatients with critical illness are influenced by various {actors. Choice of such hospitals should only be dependent on scientific and reasonable determination of patients＇ reasonable medical needs, instead of on the medical competency of the hospitals only. Conclusion Maximal cost-effectiveness should prevail, be it the class-1 demand of complete healing which is highly dependent on medical technology, or class-2 demand requiring repeated hospitalizations and not highly dependent on medical technology. Reasonable designation of hospitals for critical illness should be based on reasonable medical needs of patients, instead of medical competency of hospitals only.