基于结构变动度的江西省城市医联体实施效果评价研究

Evaluation of the implementation effect of urban Medical Cluster in Jiangxi Province based on structural change degree

目的:评价江西省城市医联体实施效果,为推进城市医联体的建设发展提供参考。方法:对两家城市医联体资源下沉、能力提升和经济负担三方面的实施效果进行描述性分析,运用结构变动分析其变动情况。结果:城市医联体A基层诊疗人次占比由29.29%增长至35.38%,成员医院诊疗人次不断增加,牵头医院与成员医院次均费用稳步增长;城市医联体B基层诊疗人次占比由73.80%下降至55.05%,牵头医院与成员医院B2诊疗人次不断增长,成员医院B2次均费用持续下降。结构变动分析结果显示,2018-2020年,在诊疗量方面,城市医联体A牵头医院呈负向变动,贡献率为50%,而城市医联体B牵头医院呈正向变动,贡献率为47.17%;两家城市医联体牵头医院与成员医院患者次均费用呈正向变动,贡献率最高的分别为成员医院A2(49.96%)、成员医院B2(50%)。结论:城市医联体A资源下沉、能力提升取得一定成效,牵头医院是主要影响因素;城市医联体B总体效果更好,减轻患者经济负担效果显著,成员医院B2是主要影响因素。

Objective:To evaluate the implementation effect of the urban Medical Cluster in Jiangxi Province,so as to provide a reference for promoting the construction and development of the urban Medical Cluster.Methods:This paper used descriptive analysis to analyze the implementation effects of resource sinking,capacity improvement,and economic burden of the two urban Medical Clusters,and analyzes its changes by using structural changes.Results:The proportion of grassroots clinicians visits in the urban Medical Cluster A increased from 29.29%to 35.38%,the number of visits to member hospitals kept increasing,and the average cost per visit of leading hospitals and member hospitals increased steadily.In urban Medical Cluster B,the proportion of grassroots clinicians visits decreased from 73.80%to 55.05%.The number of B2 visits in the leading hospitals and member hospitals kept increasing,and the average cost of B2 visits in member hospitals kept decreasing.The results of the structural change analysis show that from 2018 to 2020,in terms of medical treatment volume,the hospital led by urban Medical Cluster A showed a negative change with a contribution rate of 50%,while the hospital led by urban Medical Cluster B has a positive change with a contribution rate of 47.17%;the two urban cluster lead hospitals showed positive variation in the average cost per patient with member hospitals,with the highest contribution from member hospital A2(49.96%)and member hospital B2(50%)respectively.Conclusion:The resources of urban Medical Cluster A have sunk and the capacity has been improved to some extent,and the leading hospital is the main influencing factor.The overall effect of urban Medical Cluster B is better,and the effect of reducing the economic burden of patients is significant.Member hospital B2 is the main influencing factor.