医联体模式对患者疾病经济负担影响因素的实证研究——基于对湖南省C市重大疾病脑卒中患者的分析

An Empirical Study on the Factors Influencing the Economic Burd en of Disease in Patients with Medical Association Model

新一轮医疗改革正在通过建立医联体模式构筑分级诊疗的新型医疗体系,期望通过新体系的运行逐步解决“看病难、看病贵”的社会问题。采用科学、客观的方法分析医联体建设和运行过程中的相关影响因素,有助于指导合理调整医疗改革方案。本研究选取湖南省C市重大疾病脑卒中医联体中400名脑卒中患者进行回顾性队列研究,构建基于重大疾病脑卒中患者视角下医联体模式对疾病经济负担影响因素的效用函数。实证结果表明:医保政策、患者身体状况、患者健康观念、住院周期四类因素是医联体模式下影响重大疾病患者疾病经济负担的主要因素。为优化医联体体系建设、减轻患者疾病经济负担,应有效利用医保政策这一杠杆,通过紧跟政策、灵活多样、合理监管的医保差异化政策宏观调控医疗资源和患者就医趋向;应落实、巩固三级预防体系,立足根源构筑有效的医联体健康管理和疾病维护良性循环。

The new round of medical reform is building a new medical system of hierarchical diagnosis and treatment through the establishment of medical association model,hoping to gradually solve the social problems of"difficult and expensive to see a doctor"through the operation of the new system.It is helpful to guide the reasonable adjustment of the medical reform plan to use scientific and objective method to analyze the relevant influencing factors in the construction and operation of the medical union.In this study,a retrospective cohort study was conducted on 400 stroke patients in the TCM combination with severe diseases in C City of Hunan Province,and a utility function was constructed based on the effect of the medical combination model on the economic burden of diseases from the perspective of stroke patients with major diseases.The empirical results show that medical insurance policy,patients'physical condition,patients'health concept and hospitalization cycle are the main factors that affect the economic burden of patients with serious diseases under the medical combination model.In order to optimize the construction of the medical consortium system and reduce the disease economic burden of patients,the leverage of medical insurance policy should be effectively used to macro-control medical resources and patients'medical treatment trend through differentiated medical insurance policies that follow the policies,are flexible and diversified,and are reasonably supervised,implement and consolidate the tertiary prevention system,and build a virtuous cycle of effective health management and disease maintenance of the medical consortium based on the root causes.