县域医共体总额预付激励效应的影响因素研究——基于24个案例的清晰集定性比较分析

A study on the influencing factors of total prepayment incentive effect of county medical communities:A clear set qualitative comparative analysis based on 24 cases

目的:发现影响制约医共体医保总额预付改革激励效应的因素,为促进县域医共体医保总额预付改革提供研究证据。方法:以样本地区医共体医保总额预付政策文本及其激励效应为研究对象,采用清晰集定性比较分析方法揭示医共体医保总额预付模式的设计要素与其激励效应之间的因果关系。结果:超支分担、购买服务范围、结算方式是影响医共体医保总额预付方案激励效应的决定性因素。结论:采取供方承担超支风险、购买服务范围包含县域外医疗服务和预付制结算方式的设计,有利于提高医共体医保总额预付模式的激励效应。

Objective:To identify what factors affect the incentive effect of the reform of total medical insurance prepayment in the medical community,and to provide research evidence for improving the total medical insurance prepayment of the county medical community.Methods:Text of the total medical insurance prepayment policy and its incentive effects in sample regions is taken as the research object,and a clear set qualitative comparative analysis method is used to reveal the causal relationship between the design elements of the total medical insurance prepayment and its incentive effects.Results:It is found that overspending sharing,purchasing service scope,and settlement method are the main factors that affect the incentive effect oftotal medical insurance prepayment plan of the medical community.Conclusions:Adopting the design of the supplier bearing the risk of overspending,purchasing service scope including medical services outside the county,and adopting a prepayment settlement method are conducive to improving the incentive effect of the total medical insurance of the medical community.