县域医疗服务共同体改革前后医疗费用情况对比分析——以安徽省阜南县为例

Comparative analysis of medical expenses before and after the reform of county medical alliance:A case study of Funan county in Anhui province

目的了解县域医疗服务共同体(简称县域医共体)改革给患者带来的医疗费用变化,对医共体政策带来的影响进行评价,明确医共体改革给基层群众带来的福祉和影响。方法对阜南县医共体改革前后的住院量、医疗总费用、医疗总费用中医保可报销费用以及医保实际支付费用和个人支付费用进行统计描述。采用配对t检验对比医共体改革前后的变化。结果医共体改革后年住院量增长了26.7%,改革前人均医疗总费用增长率为9.2%,而改革后则为1.8%,人均医疗总费用增长率大幅降低;人均医保实际支付费用则依旧持续升高;而人均个人支付费用则由改革前的年度12.0%的增长率下降为改革后的6.7%的负增长,使得人均个人支付费用不断下降。改革后各项指标全县医疗总费用高于改革前,而人均个人支付费用则低于改革前,P<0.01。结论医共体改革有效地控制了个人医疗费用的上涨,同时加大了医保的投入,给基层公民来了实惠。医共体改革的实施有利于合理分配使用医疗资源,减轻各地医疗负担,降低基层人民的治疗费用,也达到了合理使用医保费用的目的。

Objective To understand the changes in medical costs brought by the county reform to patients,evaluate the impact of the medical community policy,and clarify the welfare and impact of the medical community reform on the grass-roots people.Methods The amount of hospitalization,total medical expenses,reimbursable expenses,actual medical expenses and personal expenses before and after the reform of Funan county medical community were statistically described.The paired t test was used to compare the changes before and after the reform.Results After the comparison of the data before and after the reform,it was found that the amount of hospitalization increased by 26.7%in the year after the reform,the growth rate of the per capita total medical expenses was 9.2%before the reform and 1.8%after the reform,and the growth rate of the per capita total medical expenses was greatly reduced.The real cost per capita of health insurance continued to rise;The annual growth rate of per capita personal expenditure decreased from 12.0%before the reform to 6.7%after the reform.After the reform,the total medical expenses in the county were all higher than those before the reform,while the per capita individual cost was lower than that before the reform(P<0.01).Conclusion The medical community reform has effectively controlled the rise of personal total medical expenses,increased the input of medical insurance,and brought benefits to grass-roots citizens.The implementation of the medical community reform is conducive to the rational allocation and use of medical resources,reducing the burden of medical care in various localities,and reducing the treatment costs of the people at the grass-roots level,and achieving the purpose of rational use of medical insurance costs.