公立医院制度性诱导下资金流转模型实证分析——以上海市为例

An Empirical Analysis of Capital Flow Under Institutional Inducement of Public Hospitals: a Case Study of Shanghai

目的分析上海市公立医院医疗费用增长情况,甄别上海市公立医院医疗费用增长中外部因素、内部诱导服务对医疗费用增长的贡献程度。同时通过实证分析,验证公立医院医疗费用增长系统动力模型的可行性和有效性。方法以公立医院医疗费用增长系统动力量化模型为方法学基础,收集实证地区相关数据,带入模型模拟。结果以2010年为基准年,到2019年上海市公立医院总资金增长了1143亿元。总增长中外因带来的常规增长占51%,诱导导致的增长占36%,约13%的资金增长属于财政投入增加带来的总资金增长。结论通过实证建模分析,检验了模型结构与行为的一致性,确保模型的真实性和有效性。方法学实证结果经样本地区卫生健康行政部门和研究机构等各类专家反复咨询论证,符合目前医疗服务系统运作特征。

Objective To analyze the increase of medical expenses in public hospitals in Shanghai,and to identify the contribution of external factors and internal induced services to the increase of medical expenses in public hospitals in Shanghai. Through empirical analysis,verify the feasibility and effectiveness of the system dynamic model of public hospital medical cost growth. Methods Based on the quantitative model of the system dynamics of the growth of medical costs in public hospitals,the relevant data of empirical areas were collected and brought into the model simulation. Results Taking 2010 as the base year, the total funds of public hospitals in Shanghai in 2019 was increased by 114.3 billion yuan. The total growth of conventional growth caused by foreign factors accounted for 51%,and the growth caused by inducement accounted for 36%. The remaining 13% of the increase is attributable to the increase in total funds brought by the increase in fiscal input. Conclusion Through empirical modeling analysis,the consistency of model structure and behavior was tested,and the model data simulation and statistical tests were carried out to ensure the authenticity and validity of the model. The empirical results of the methodology were repeatedly consulted and demonstrated by various experts from health administration departments and research institutions in sample areas,which were in line with the operational characteristics of the current medical service system and proved the effectiveness of the methodology.