三明市医共体总额预付对医疗服务下沉的影响分析

Analysis of the impact of global budget payment on care shifting from hospitals within medical communities in Sanming city

目的:分析三明市医共体总额预付改革对医疗服务下沉的影响。方法:收集2016—2019年三明市医共体运行和医保收支数据,通过描述性分析和间断时间序列模型对医共体、医院及基层医疗机构的医疗服务数量及效率变化、医保基金运行情况进行分析。结果:总额预付改革后,医共体内医院门急诊服务量占比由63.3%下降至58.1%,基层医疗机构占比呈上升趋势;2016—2019年医院住院服务量占比和每百人门急诊住院人次数显著减少。医保基金总体结余率由2016年的8.2%降至2019年的2.6%。结论:三明市总额预付改革实施后医保基金总体运行平稳,医共体医疗服务效率有所提升,医疗服务逐步下沉,医院住院人次数下降,基层住院患者占比有所上升。建议各地开展医共体总额预付制改革时应合理制定医共体预算总额,完善医共体内部分配制度与协作机制。

Objective:To analyze the impact of the global budget payment reform on care shifting from hospitals within medical communities in Sanming city.Methods:Collect data on the operation within medical communities in Sanming city and medical insurance revenue and expenditure from 2016 to 2019,and use descriptive analysis and discontinued time series model to analyze the changes in the quantity and efficiency of medical services and the operation of medical insurance funds in the medical community,hospitals and primary medical institutions.Results:After the global budget payment reform,the proportion of hospital outpatient and emergency services has dropped from 63.3%to 58.1%,while the proportion of primary medical institutions have shown an upward trend;the proportion of hospital inpatient services and the number of outpatient and emergency hospitalizations per 100 people decreased significantly between 2016 and 2019.The overall balance rate of the medical insurance fund decreased from 8.2%in 2016 to 2.6%in 2019.Conclusion:After the implementation of global budget payment in Sanming city,the overall operation of the medical insurance fund is stable,the efficiency of medical services within the medical community has improved,and medical services have gradually shifted from hospitals.The number of hospital admissions has decreased,and the proportion of primary-level inpatients has increased.It is recommended that when implementing the global budget payment of the medical community,the global budget of the medical community should be reasonably formulated and the internal allocation system and collaboration mechanism of the medical community should be improved.