天津市糖尿病按人头付费改革效果评估

Effectiveness Evaluation of the Capitation on Diabetes in Tianjin

目的:探究按人头付费能否有效地控制医疗费用,为今后继续推行医保支付方式改革提供参考与借鉴。方法:采用描述性统计和倾向得分匹配等计量方法,分析糖尿病按人头付费的政策效果。结果:签约糖尿病按人头付费患者就诊次数降低,基层医疗机构的就诊率提高,患者发生总费用、自付费用、药品费用、治疗和检查费用均显著降低。结论:糖尿病按人头付费能够有效提高医疗服务的利用度,控制医疗费用的过快上涨,降低患者经济负担的同时,也减轻了医保基金的运营压力。

Objective:It explores whether capitation reduce medical expenses or not,which also provides references for the further reform of medical insurance payment system.Methods:Descriptive statistics and propensity score matching are applied to analyze the effect of capitation on diabetes.Results:The outpatients covered by capitation reduce the frequency of visit and increase proportion of doctors at primary health-care institutions,while the total and out-of-pocket medical cost decrease significantly,as well as drug and treatment cost.Conclusion:Capitation on diabetes can improve the use of medical services,reduce the rapid increase in medical costs as well as medical burden of patients and health care funds.