广东省县域医疗卫生服务利用现状研究

Current status research on utilization of county medical and health services in Guangdong Province

目的 调查广东省县域医疗卫生服务利用状况,并为县域医疗卫生改革提供建议。方法 以广东省57个县(县级市)的基层医疗卫生机构及县级公立医院为研究对象,收集2018~2019年上述医疗卫生机构卫生服务利用状况数据,包括县域就诊流向、县级公立医院收入结构、医疗资源使用效率及患者医疗费用控制。结果 2019年广东省57个县(县级市)的县域内住院率达84.1%。与2018年相比,2019年广东省57个县(县级市)的县级公立医院及基层医疗卫生机构的门诊量分别增加了268.89万人次、184.38万人次;基层医疗卫生机构的出院人数无明显变化,县级公立医院的出院人数增加13.72万人;县级公立医院的技术劳务性收入占医疗收入的比例上涨了2.24个百分点,药品收入占医疗收入的比例下降了0.5个百分点;基层医疗卫生机构的门急诊人次平均收费和出院患者平均医药费均有所下降,下降幅度超过20%,而县级公立医院的门急诊人次平均收费和出院患者平均医药费均有所上升。结论 广东省县域患者向县域内医疗机构回流,基层医疗卫生机构的医疗卫生服务可及性增强,但还应进一步提升住院服务能力;县级公立医院运行状况趋向优化,但医疗卫生服务能力离实现“大病不出县”的目标还有一定差距;应针对性地增强县域各级医疗卫生机构的医疗水平与服务能力,并通过构建整合型的卫生服务体系来提升整体医疗卫生服务能力和医疗卫生服务利用的均衡性。

Objective To investigate the utilization status of county medical and health services in Guangdong Province,so as to provide suggestions for the reform of county health care.Methods The primary medical and health institutions and county-level public hospitals in 57 counties(county-level cities) in Guangdong Province were taken as the research objects.The data of health service utilization in the above medical and health institutions from 2018 to 2019 were collected,including the flow of county medical visits,income structure of county-level public hospitals,utilization efficiency of medical resources,and control of patients′ medical expenses.Results In 2019,the intra-county hospitalization rate of 57 counties(county-level cities) in Guangdong Province reached 84.1%.Compared with 2018,the outpatient visits of county-level public hospitals and primary medical and health institutions in 57 counties(county-level cities) in Guangdong Province increased by 2.688 9 million of person-time and 1.843 8 million of person-time in 2019,respectively.There was no significant change in the number of discharged patients in primary medical and health institutions,while the number of discharged patients in county-level public hospitals increased by 137 200.The proportion of technical labor income in medical income of county-level public hospitals increased by 2.24 percentage points,while the proportion of drug income in medical income decreased by 0.5 percentage points.The average outpatient and emergency charges of person-time,and the average medical expenses of discharged patients in primary medical and health institutions were both decreased,and decreased by more than 20%,while the average outpatient and emergency charges of person-time,and the average medical expenses of discharged patients in county-level public hospitals were both increased.Conclusion The patients from county areas in Guangdong Province return to medical and health institutions within county areas,and the accessibility of medical and health services in primary medical and health institutions is enhanced,but the inpatient service capacity should be further improved.The operation of county-level public hospitals tends to be optimized,but there is still a gap between the medical and health service capacity and the goal of "serious diseases would not leave the county".The medical level and service capacity of medical and health institutions at various levels in county areas should be enhanced accordingly,and the balance between the overall medical and health service capacity and the utilization of medical and health services should be improved by establishing an integrated health service system.