浙江省德清县县域医共体改革措施与效果分析

Measures and effects of the pilot of county-based healthcare network in Deqing county of Zhejiang province

目的:分析浙江省德清县县域医共体改革措施及阶段性成效。方法:定性访谈了解医共体整合措施,定量分析医共体建设前后(2016—2018年)各级医疗机构医疗服务利用数据及医共体部分绩效考核数据。结果:医共体在组织、管理、功能、服务方面进行整合,并取得阶段成效:医保基金在县域内支出率有所增加;乡镇卫生院卫生人员数量、医疗收入有所提高,乡镇卫生院住院病人人均医药费有所降低。结论:医共体取得初期成效,应开展以患者健康结局指标为主的长期追踪调查,全面系统评估医共体;保留基层医疗机构地位、功能定位不变;探索实行医共体“总额预付、结余奖励”制度,将医共体发展成以患者健康为中心、基于利益共享机制、分工合作的责任利益共同体。

Objective:This research is aimed at analyzing measures and outcomes of the county-based healthcare network(in the piloting phase)in Deqing county of Zhejiang province.Methods:Qualitative interview was conducted to understand the integration measures.The 2016—2018 medical service utilization data and performance evaluation results of medical institutions at all levels in the county were collected and analyzed for the status quo before and after the establishment of the county-based healthcare net-work.Results:The integration measures were adopted in four dimensions of organization,management,function and service in Deqing County.The rate of medical insurance expenditure in the county kept on increasing;the number of health personnel and general income in the township hospitals has increased;and the Per capita medical expenses for inpatients in township hospitals underwent a decreasing trend.Conclusions:Deqing s county-based healthcare network has made initial achievements so far.In order to comprehensively find out the implementation effect of the county-based healthcare network,it is highly needed a long-term follow-up investigation based on patient-level health outcome indicators.The independent legal entity status and function of primary health care institutions need to be insured,and the global prepaid payment method has to be implemented.All those measures are used to develop county-based healthcare network into a network which focuses on the patients health and based on the benefit sharing and cooperation mechanism.