县域医共体试点对基层医疗卫生机构的早期影响研究

Pilot projects of county-level healthcare community in China:Its early impacts on primary health institutions

县域医共体试点建设在路径框架上显现趋同性,体现为内部治理结构、医保支付方式、人事薪酬制度改革以及信息系统整合等模式特征,同时存在体制机制改革程度的差异。文章选取山西、浙江、山东等地的4个县域医共体试点运行数据进行定量与定性分析。初期运行数据显示,医保基金县域内支出率有不同程度的提升,其中3个县域内医保基金基层支出率显著增加。乡镇卫生院主要业务增量来自县级医院特定专科的住院下沉,住院收治能力短期内获得显著提升,但乡镇卫生院门诊补偿人次占比增幅小于住院,门诊业务下沉效果不明显。该研究为县域医共体试点运行早期对县域内患者就诊流向的结构性改变、对基层医疗卫生机构服务能力的变化趋势提供了初探性证据,未来需进一步开展县域医共体试点政策环境下乡镇卫生院医疗服务能力变化的系统性跟踪评价研究。

Pilot projects of county-level healthcare community have shown convergence on their path framework,which is reflected in the internal governance structure,payment schemes,personnel compensation system reform,and information system integration.Meanwhile,differences also exist in the reform of institutional mechanism.In this paper,the data of 4 pilot projects of county-level healthcare community in provinces of Shanxi,Zhejiang and Shandong were analyzed quantitatively and qualitatively.The initial operation data indicated that the within-county expenditure rate of the medical insurance increased to varying degrees,and the share of primary-care expenditure increased significantly in 3 pilot counties.The majority increase of service volume in the township health centers came from the inpatient redistribution of specific specialized departments in county hospitals.The hospitalization capacity was significantly improved in the short term.However the increase in the share of outpatient for township health centers was milder than that of inpatients,which did not show obvious effects.This study provided preliminary evidence for the early impacts of pilot projects of county-level healthcare community on structural change in the flow of patients seeking healthcare services and trends in the service capacity of primary healthcare institutions.It is necessary to carry out a further systematic follow-up evaluation of the changes in healthcare service capabilities of township health centers after the implementation of pilot projects of county-level healthcare community.