医疗保险改革后上海市急性传染病报告质量调查

A survey on the quality of report of acute communicable diseases in Shanghai after medical treatment insurance reform

[目的 ] 了解上海市医疗保险后传染病疫情报告、传染病监测以及传染病访视、调查处理等工作变化 ,探讨适应本市急性传染病预防控制工作方法模式。 [方法 ] 选择有代表性的全市 7个区、县的 2 1家医疗机构开展此项调查工作。 [结果 ] 医疗保险后急性病毒性肝炎发病至初诊和初诊至确诊的时间显著比医保前长 ;医疗保险后传染病住院人次下降 ;肝炎、菌痢、伤寒、肺结核等传染病医疗总费用下降 ;肝炎门诊人次上升 ,平均医疗费用上升 ;肠道门诊人次上升 ,平均医疗费用下降 ;传染病监测数量及质量、病家访视质量无变化。 [结论 ] 将预防保健逐步纳入医疗保险范围 ,实施相应的传染病防治工作办法 ,将会大大提高传染病的防治效果。

To understand the changes in the report of infectious diseases, surveillances of infectious disease and home visit of infectious diseases in Shanghai city after the medical treatment insurance reform, and to explore a new model to suit the prevention and control of the acute infectious diseases in the city . 21 medical institutions in seven representative districts and counties were selected for investigation. The time lag from on set of acute viral hepatitis to first visit of clinic and from first visit to definite diagnosis was apparently longer after the medical treatment insurance than before. Number of patients hospitalized for infectious diseases dropped after medical treatment insurance. The total costs of medical treatment of infectious diseases such as hepatitis, bacillary dysentery, typhoid fever and pulmonary tuberculosis etc decreased after the medical treatment insurance. Visit of hepatitis patients to outpaint departments increased with the increase of average medical treatment cost. More diarrheal patients visited intestinal outpaint departments with decrease of the average medical treatment cost. Quantity and quality of survillance of infectious diseases and quality of home visits to patient were stable. [Conclusion] If preventive medicine be included into medical treatment insurance the control of infectious diseases will be improved.