深圳市新医改实施对社康中心全科门诊的影响研究

Influence of new medical reform of Shenzhen on outpatient clinics of community health center

目的了解新医改政策实施后社康中心全科门诊各项指标的变化,探讨新医改推进过程存在的问题,提出相应的建议,评价政策的长期效果。方法对比分析2011年7月1日—2012年6月30日(新医改前1年)和2012年7月1日—2013年6月30日(新医改后1年)深圳市沙井街道20家社康中心各项门诊指标。主要分析医改前后总诊疗收入、诊疗人次、诊疗次均费用、药品收入、门诊输液率等的变化。结果社康中心总诊疗收入略有下降,降幅为0.34%;诊疗人次大幅度下降,降幅达到20.68%;诊疗次均费用明显升高,增幅为25.65%;药品收入下降,降幅为18.17%;输液率大幅度下降,由医改前的17.88%下降到医改后的6.39%,下降了11.49%,下降幅度为179.81%。结论一般诊疗费的设置欠合理,零差率的药品品种偏少,社康中心患者流失严重,应设立医改评估机制,对医改进行及时评估,按病种分类定价诊疗费和建立合理的用药体系。加强配套综合改革,增加政府投入,实行全民医保和社康中心收支两条线,切实减轻患者的医疗负担。

Objective To investigate the changes of each index for general clinic of community health center after the im- plementation of new medical reform, discuss on the problems in the new advance the reform process, try to put forward suggestions, and evaluate the long-term effects of the policy. Methods The clinic index before（ from July 1,2011 to June 30,2012） and after（July 1,2012 to June 30,2013） the implementation of new medical reform of 20 community health service center in Shajing Street of Shenzhen City were compared. The total income of diagnosis and treatment, number of patients, expenses of each diagnosis or treatment, proportion of the drug treatment, rate of outpatient with infusion solution, etc. were compared before and after the implementation of new medical reform. Results The overall income declined slightly（ by 0.34% ） ;the number of patients reduced obviously（ by 20.68% ） ;the expenses of each diagnosis or treatment increased significantly（ by 25.65% ） ;the drug income decreased（ by 18.17% ） ;the rate of outpatient with infusion solu- tion sharply decreased by an average of 17.88% as compared to that（an average of 6.39% ） before medical reform,fell by an average of 11.49%, the extent of decrease at 179.81%. Conclusion The install of common medical fee is not rea- sonable enough. The varieties of Zero Slip medicines are less. Patients of community health centers have a massive loss. The health assessment mechanism should be established for rationality of medical reform in time. To price the expenses of each diagnosis or treatment according to the classification of the disease and establish the reasonable medication system ; to strengthen the comprehensive reform, increase government investment, carry out universal health insurance and community health center two lines of revenue and expenditure, and reduce the medical burden of patients.