济宁市“先看病后付费”医疗服务改革效果评价分析

Outcomes analysis and evaluation of the ＂treatment before payment＂ reform in Jining

目的评估分析“先看病后付费”实施效果，提供规避风险有关方案建议。方法采用回顾性描述分析，对医疗机构按实施“先看病后付费”前后监测数据进行对照。结果实施“先看病后付费”的医疗机构医疗服务质量、效率、费用等关键要素均发生明显变化，有效释放患者就医需求，使医疗机构卫生技术人员的工作负荷、工作效率明显提高，平均住院日、药占比均得到有效控制，医保住院患者总费用得到合理控制，患者自付就医经济负担进一步减轻。结论排除其他干扰因素，“先看病后付费”可以让患者得实惠、医疗机构得发展。但在实施过程中存在一定风险，应继续完善配套措施予以规避。

Objective To evaluate outcomes of the reform and recommend on risk avoidance. Methods The retrospective descriptive analysis was called into play to compare the surveillance data of the medical institutions before and after the reform. Results Significant changes have been identified in such key elements of the institutions as medical service, quality of care, efficiency, and costs. Improvements include effective release of the medical needs of patients, much higher efficiency of medical staff, shorter days of stay, and drug proportion, in addition to reasonable control of the total inpatient expenses, and further cutback of the patient＇s out-of-pocket burden. Conclusion With other factors excluded, the reform can benefit the patients and help medical institutions development, if risks are avoided and measures improved.