北京市综合改革背景下本地居民与外来就医患者医疗机构治疗费用受益人群构成分析

Analysis on the Composition of the Beneficiaries of Medical Institutions between Residents and Non-residents under the Comprehensive Reforms in Beijing

目的:在北京市“医药分开”“医耗联动”综合改革背景下,通过对本地居民和外来就医患者受益人群进行分析,为下一步卫生政策的精准制定和调整提供数据参考。方法:采用多阶段分层、整群抽样调查的方法,利用卫生费用核算体系2011核算2019年北京市医疗机构治疗费用及受益人群构成。结果:2019年北京市医疗机构治疗费用以本地居民为主,外来就医患者费用占比为27.33%,外来就医患者门诊、住院次均费用均高于本地居民,本地居民和外来就医患者治疗费用在机构流向、年龄别、疾病别构成等方面均存在差异。结论:本地居民和外来就医患者治疗费用中,中老年患者、慢性非传染性疾病均是费用消耗的主体,外来就医患者主要利用优质医疗资源的住院服务,整体构成呈年轻化,主要流向疑难杂症或北京市优势病种。因此,北京市应加强区域间协作,在政策制定、评价、资源配置等方面,精准考虑不同人群的需求。

Objective:To analyze the beneficiary composition of the treatment expenses of residents and non-residents of Beijing under the comprehensive reforms of"medical-pharmaceutical separation"and"medical consumption linkage"in Beijing and provide a better data reference for the precise formulation and adjustment of health policies in the future.Methods:A multi-stage stratified cluster sampling method was used to conduct the survey.A System of Health Accounts 2011(SHA 2011)was used to calculate the treatment costs of medical institutions and the composition of the beneficiary population in 2019.Results:In 2019,the treatment costs of medical institutions in Beijing were mainly consumed by residents,and the cost of non-residents accounted for 27.33%.The average cost per time for both outpatients and inpatients of non-residents’were higher than those of residents’.There were differences in the treatment costs of residents and non-residents in terms of institutional flows,age compositions,and disease compositions.Conclusion:Among the treatment costs of residents and non-residents,middle-aged and elderly patients,and patients with non-communicable diseases with chronic diseases were the main sources of expenditure.Non-residents in Beijing mainly used high-quality medical resources for inpatient services.The overall composition of non-residents who seek medical care in Beijing was younger and their expenses were mainly paid for intractable diseases or dominant diseases in Beijing.The government should strengthen inter-regional collaboration,and accurately consider the needs of different groups of people in policy formulation,evaluation,and resource allocation.