天津市糖尿病门诊特定病种患者按人头付费的效果评价

Effectiveness evaluation of capitation on diabetes outpatients in Tianjin

目的从需方角度分析天津市糖尿病按人头付费的试点效果,为进一步完善"按人头付费"改革提供依据。方法自行设计问卷,在6家二级试点医疗机构抽样调查910名糖尿病患者,包括按人头付费组和按项目付费组。结果按人头付费组患者的血糖控制情况不差于按项目付费组,且医疗费用更低,总体满意度更高。结论天津市糖尿病门诊特定病种患者按人头付费取得了一定成效,但仍需加强有效的健康教育及其与患者自我管理的结合,完善人头费标准的制定并建立动态调整机制,持续追踪和评价针对特定病种的按人头付费方式。

Objective To evaluate the effectiveness of pilot of capitation reform on outpatients with diabetes in Tianjin from provider and demanders’perspectives,and to provide reference for capitation reform.Methods A self-designed questionnaire was used to investigate 910 randomly selected diabetic patients,including outpatients of capitation group and fee-for-service group in six secondary pilot hospitals.Results Blood glucose control in patients of capitation groups was not worse than those of fee-for-service group.Compared to patients of fee-for-service group,medical expense of patients of capitation group was lower,and the overall patient satisfaction was higher.Conclusion The capitation reform on outpatients with diabetes in Tianjin has achieved some effects.However,the combination of effective health education and self-management still needs strengthening.It is suggested to improve the formulation of capitation criteria,establish its dynamic adjustment mechanism,continuously follow up,and evaluate capitation method for specific diseases.