医改前后贵州省各级医疗机构诊疗人次与入院人数变化分析

The Number Changes of Visits and Inpatients in Medical Institutions at Different Levels in Guizhou Province before and after Health Care Reform

目的：通过分析贵州省各级医疗机构诊疗人数变化情况,探讨新医改的成果及存在的问题,为进一步完善医改的制度和政策设计提供依据.方法：利用《中国卫生统计年报》资料及《中国卫生统计医改监测》资料,对贵州省2008～2011年县级及以上医院、乡镇卫生院和村卫生室等医疗卫生机构就诊人次数、入院人数及其构成比、环比增长情况进行描述性分析.2008年和2009年为医改前,2010年和2011年为医改后.结果：2008～2011年,贵州省医疗机构诊疗人数整体呈增加趋势,但不同机构间有较大差异.新医改后,县级及以上医院门诊就诊人次数及入院人数都保持了较强劲的增长趋势,2011年增长率分别达14.7％和14.8％;而乡镇卫生院、村卫生室和其他医疗机构就诊人次数增长有逐年减缓的趋势,其中,乡镇卫生院2011年门诊就诊人次数增长率为-1.7％.2010年和2011年入院人数增长率分别为-8.6％和-7.9％,门诊就诊人次数及入院人数占全省的比例逐年下降.结论：新医改后居民就诊和住院流向有向县级及以上医院集中的趋势,这有可能进一步加剧“看病难”和“看病贵”.

Objective： To analyze the number changes of visits and inpatients in medical institutions at different levels in Guizhou province before and after health care reform, and to explore the achieve- ments and the problems in new health care reform, and so as to provide evidences for improving the sys- tem and policy design of health care reform. Method： ＂ China Health Statistics Annual Data ＂ and ＂ China Health Reform Statistics Monitoring Data ＂were utilized, and the number of visits and inpatients, the constituent ratio and growth ring in hospitals at or above county level, health centers in townships and health care clinics in villages in Guizhou province were analyzed descriptively before （ from 2008 to 2009）and after （from 2010 to 2011 ）health care reform. Result： From 2008 to 2009, the numbers of visits and inpatients in medical institutions in Guizhou province showed an increasing trend with great differences in different institutions. After new health care reform, the numbers of visits and inpatients in hospitals at or above county level maintained a strong growth trend, which were 14.7% and 14.8% in 2011 respectively. But the numbers of visits and inpatients in health centers in townships, health care clinics in villages and other medical institutions showed a slowing trend. In health centers in townships,the growth rate of visits was - 1.7% in 2011, and the growth rates of inpatients in 2010 and 2011 were -8.6% and -7.9%, respectively, and the visit and inpatient numbers accounted for the total province＇s ratio decreased year by year. Conclusions： After new health care reform, there is a trend that the visits and inpatients concentrate to hospitals at or above county level, which may aggravate inadequate and overly expensive medical services.