按人头支付政策干预对患者住院服务利用的影响分析

Impact Analysis of Inpatients' Medical Service Utility by the Policy Intervention of Capitation Payment

目的:分析按人头支付政策干预对参合对象住院服务利用的影响。方法:收集2011—2015年浦东新区按人头支付干预前后新型农村合作医疗参合对象住院服务利用相关数据,通过比较分析,评价政策干预对参合对象住院服务利用的影响。结果:超过70%的住院医疗服务利用发生在二三级医疗机构,且政策干预后更加向二三级医疗机构集中;其中二级医疗机构2015年住院人次数占52.58%,住院费用占61%;从环比增速来看,二三级医疗机构次均住院费用增速分别从政策干预前的31.49%和8.58%下降到2015年的3.84%和4.05%。结论:参合对象的总体住院服务利用次数和费用均逐年增加,二级医疗机构住院费用增长趋势明显;政策干预后二三级医院参合对象次均住院费用的增长得到明显遏制。

Objective： To evaluate the effect of capitation payment policy intervention for medical service utility of the insured in- patients. Methods： To compare and analyze the intervention impacts on inpatients＇ medical service utility by collecting inpatients＇ medical service utility data before and after the capitation payment policy intervention in NCMS in Pudong New Area from the year of 2011 to 2015, Results： Over 70% medical service utility of inpatients was happened in second ＆ third degree hospitals, and it was more and more concentrated in those institutions after the policy intervention. In the year of 2015, 52.58% number of admissions was in secondary hospitals, and the fees proportion was 61%. From the view of year-over-year growth, before intervention the growth rates of inpatient cost per visit in second ＆ third degree hospitals respectively were 31.49% and 8.58%, which decreased to 3.84% and 4.05% in the year of 2015. Conclusion： The general visit times and expenses of insured inpatients were going up year by year, espe- cially in second ＆ third degree hospitals. The policy intervention resulted in a well impact on the suppression of expenses increase of insured inpatient cost per visit.