合理患者流向带来的经济效益分析与影响

Analysis and Influences of the Economic Benefits Brought by the Reasonable Flow of Patients

目的:近年来我国医疗资源和患者急聚在大城市的倾向越来越明显,导致医疗费用飞速的增加,随着全国医疗卫生服务体系规划纲要(2015—2020年)和分级诊疗制度指导意见的出台,患者的合理流向是影响服务体系的关键因素,也是影响资源布局因素之一。方法:通过分析不同级别医院病例住院天数及病种,结合专家的访谈,明确出哪些住院患者可以转为门急诊治疗;通过随机抽取不同级别医院一定的病例,选取副主任以上职称医生,根据疾病病情诊断、治疗等情况判断是否在本级医院住院,明确出住院患者分流比例,根据门诊和住院的分流比例,结合不同级别医院门诊和住院平均费用,计算出患者合理分流节约的经济效益。结果:按照只考虑住院患者分流前后的节约医疗费用,辽宁省和全国节约直接医疗费用占2013年全部住院医疗费用占比分别为10.50%和10.80%。按照部门住院患者转门诊治疗及住院患者合理流向分流后,辽宁省和全国节约直接医疗费用占比分别为21.80%和23.30%。结论:患者合理流向带来经济效益是巨大的。因此建议从不同机构间合作提高医疗质量,专科特色减少不合理竞争,患者健康教育来塑造就医文化。

Objective： There was a increasing trend of health resources and patients accumulated in the large cities in recent years in China, which resulted in the increasing of health expenses. With the adventure of National Heahh Services System Plan（2015-2020） and the guideline of grading referral system, the reasonable flow of patients was the key factor to influence health service system and the distribution of health resources. Methods： Through the analysis of average hospitalization days, disease category and expert advice, it could make clear of which parts of patients in inpatient could be transferred to outpatient. Through the randomization of certain cases in different hospitals, the senior doctors selected need determine whether or not the case should be inpatients in their hospitals accord- ing to the diagnosis of case, treatment and the capability of the lower level of hospitals. It could account the proportion of triage medi- cal. On the hasis of the ratio of triage of inpatients and outpatients, combining the average expenses of different level of hospitals, it could get the economic benefits.of the reasonable flow of patients. Results： Considering the direct medical cost of inpatients of flow, the save proportions of Liaoning and the nation were 10.50% and 10.80% of all hospitalization expenses in 2013. According to part of outpatients to inpatients and the reasonable flow of inpatients, the save proportions of Liaoning and the nation were 21.80% and 23.30% of all hospitalization expenses in 2013. Conclusion： The reasonable flow of patients had great enormous ecCmnmic benefits. Therefore, it proposed to increase the quality of medical care by cooperation of different agencies, decrease unfair competition by spe- cialist features and shape the culture of medical treatment by patient health education .