基于“移动医院”的新农合即时结报模式在京北山区家庭医生巡诊服务中的应用

The application of the new rural cooperative medical system clinic report based on “Mobile Hospital” in the family doctor surveillance service in the mountain area of Beijing

目的了解在京北山区家庭医生巡诊时提供新农合即时结报服务在解决山区老年居民和低收入人群就医不便、医疗费用垫付造成的经济压力和推进基本医疗卫生服务均等化等方面的作用,同时探讨现有做法中存在的问题并提出改进建议。方法家庭医生团队在下乡巡诊时除携带血压计、心电图机、快速血糖检测仪、采血针、采血管等医疗设备外,同时携带常用药品和安装了HIS系统和收费报销系统的笔记本电脑以及发票打印机等设备,通过3G网络或"村村通"网络接入区卫计委信息平台。在巡诊工作中,全科医生、社区护士、防保人员主要负责建立健康档案、开展慢病管理、常见病诊疗以及家庭医生签约等工作,药剂人员提供药事服务,主要负责辅助检查项目和药品收费以及药品发放工作并实现即时结报。收集巡诊中新农合患者就诊情况和即时结报情况,并与同时期社区卫生服务站相关数据进行比较。结果巡诊患者中,年度初诊患者比例、未达新农合起付线就诊患者比例明显高于门诊患者,人均新农合垫付金额低于门诊患者。巡诊诊疗人次与服务站门诊相当,完善健康档案、慢病患者管理等工作开展数量高于门诊。结论在京北山区开展巡诊新农合即时结报工作有利于解决深山区居民就医不便、减轻其垫付医药费用的经济压力,进而提高基本医疗卫生服务的可及性和公平性。

Objective To understand the role of the new rural cooperative medical service in solving the problems such as inconvenience of medical treatment for the elderly and low-income people in the mountainous area and the economic pressure and promoting and equalization of basic medical and health services, which caused by the advance of the medical expenses in the mountainous area of Beijing, and to explore the existing problems in the existing practice and make rec- ommendations for improvement. Methods The Family doctors in the countryside carry the HIS system and charge reim- bursement system, notebook computers and invoice printers and other equipment, through the 3G network or ＂village＂ network access to the District Planning Commission information platform. In the rounds of work, general practitioners, community nurses and health workers are mainly responsible for the establishment of health records, chronic disease man- agement, diagnosis and treatment of common diseases and family physician work, pharmacists pharmaceutical services, mainly responsible for the auxiliary examination and drug charges and drug release work and achieve immediate settle- ment. In the inspection of the new rural cooperative medical treatment of patients and real-time reporting situation, and the relevant data were compared with those of community health service stations. Results Patrol found that the propor- tion of patients with newly diagnosed, not up to pay the line to pay the proportion of newcomers were significantly higher than outpatients, and the amount of new rural cooperative advances per capita lower than outpatients. Rounds of visits and outpatient service station, improve the management of patients with chronic disease, health records and other work carried out which are higher than the number of outpatients. Conclusion In the nonhero mountainous area of Beijing carrying out the new rural cooperative real-time knot work is conducive to solve the medical treatment inconvenience, reduce its advance medical costs of economic pressure, thereby improving the basic medical and health services accessibility and fairness.