县域医共体建设对县级公立医院运行的影响——以浙江省为例

Impact of County-level Medical Alliance on the Performance of County-level Public Hospitals:A Case Study of Zhejiang Province

目的基于浙江省县域医共体试点地区的经验数据,定量分析县域医共体建设对县级医院运行的影响。方法通过分段回归、配对秩和检验等统计学方法,比较政策实施前后医院运行指标的变化。结果医院提升了服务效率和能力水平,留住了更多的县域内患者,并在一定程度上控制了医疗费用的不合理增长;优化了内部收支结构,提高了医疗服务技术收入占总收入的比重,增加了医务人员的收入。但居民去县级医院就诊的自付比例并未减少,医院也可能存在着为完成控费政策目标而压减住院患者数量的现象。结论县域医共体建设促使了县级医院初步建立了较科学的运行机制。建议后续建设中继续加强医疗、医药、医保等部门的联动,发挥各项政策间的叠加协同效应。

Objective Based on the experimental data from pilot areas for county-level medical alliance in Zhejiang Province,the study analyzed the impact of county-level medical alliance on the performance of county-level hospitals.Methods Statistics analysis of segment regression and matched-pairs signed-ranks test were applied to compare the changes of hospital operation indicators before and after the implementation of the policy.Results The results demonstrated that the construction of county-level medical community improved the service efficacy and ability of the county-level hospitals with more patients treated within the county,and partly controlled the unreasonable growth of medical cost.It also optimized the internal balance of payments,increased the proportion of medical technique service income and the income of medical professions.However,the percent of out of pocket did not decrease for citizens consulted in the county-level hospitals.Some hospitals may limit the number of inpatients in order to meet the requirement of controlling the increase of the total medical income.Conclusion The study indicated that the construction of county-level medical community promoted the build of a scientific operation system in county-level hospitals tentatively.Coordination among medical services,pharmaceutics and medical insurance should be further strengthened to play the synergic effects among policies during the construction of county-level medical community.