海南省医疗机构补偿机制改革对需方的影响

Effectiveness of Compensation Mechanism Reform on Demanders' Perspective in Hainan Provincehang

目的从需方的视角分析海南省医疗服务机构补偿机制改革的实施效果,为进一步完善补偿机制改革提供政策参考。方法采用描述性统计方法分析2013—2017年海南省居民的就医机构选择、门诊和住院医疗费用、实际补偿比和个人自付医疗费用等指标。结果患者的就医选择具有向上流动趋势;门诊次均费用和住院次均费用逐年增加;患者个人自付医疗费用不降反增,患者医疗负担呈现上升趋势。结论医疗保障水平的提升促进居民医疗服务需求释放,补偿机制改革过分注重管制服务价格,忽视了对服务量的控制,导致出现医疗费用上涨,医保基金支出增加,个人自付医疗费用上涨的局面。补偿机制改革没有实现"总量控制"和"向基层下沉"的目标。

Objective To evaluate effectiveness of compensation mechanism reform from demanders’perspective in Hainan Province,and to provide more basis for implementing the reform.Methods By collecting indicators’related data of selection of medical institutions of residents,actual compensation ratio and personal pay for medical care,a descriptive statistical analysis method was used in the paper.Results Patients’choice of treatment has a tendency to move to higher grade hospitals.The average cost of outpatient service and hospitalization expenses increase year by year.Outof-pocket health payments increase.There is increase trend of personal medical burden.Conclusion The improvement of medical security level promotes the increase of residents’medical service demand.The compensation mechanism reform pays too much attention to the control of service prices,and neglects the control of service volume,resulting in rising medical costs,increasing expenditure on medical insurance funds,and rising trend of personal expense.The reform of compensation mechanism does not achieve the goal of“total control of medical expenses”and“patients moving to low grade hospitals”.