北京市基层医疗卫生机构经常性卫生费用分析

摘要

Objective To investigate the financing and components of recurrent health expenses in primary healthcare institutions in Beijing,providing evidence for the formulation of relevant health policies.Methods This study was conducted between July 2016 and June 2017.The data concerning Beijing health expenses in 2015 were derived from China Statistical Yearbook 2016,Beijing Statistical Yearbook 2016,Beijing Municipal Government Healthcare Subsidies Monitoring System, Beijing Public Health Information Center,2015 Beijing Healthcare Expenditure Report and so on.The sharing coefficient was calculated based on the data of the individual cases from Beijing Healthcare Price Monitoring Platform and sample survey results of Beijing's medical institutions.Using the System of Health Accounts(SHA) 2011,the basic status,financing schemes and components(including recurrent health expenses of treatment and preventive services) of 2015 total recurrent health expenses for Beijing's primary healthcare institutions were analyzed.Results The recurrent health expenses for Beijing's primary healthcare institutions in 2015 was 13.811 billion yuan.The inputs were mainly from medical insurance reimbursement programs and Beijing municipal government subsidies(accounting for 56.14% and 27.20% respectively).The healthcare expenses of treatment and preventive services accounted for 86.96%,13.04% of the total healthcare expenses of 2015.In terms of treatment,the healthcare subsidies were mainly spent on chronic non-communicable diseases(accounting for 70.90%) if analyzed based on the GBD classification,circulation system disease(accounting for 25.88%) if analyzed in accordance with the ICD-10 standards, and patients of 50-69 years old if analyzed according to the age group.When it comes to the preventive services,the healthcare subsidies were mainly spent on the implementation of state-sponsored immunization programs,chronic disease prevention and control,elderly health management,resident's health record management,accounting for 24.86%,13.33%,10.37%, 10.05%,respectively.Conclusion The healthcare inputs for primary healthcare institutions in Beijing are mainly from public funding.Our study results indicates that the recurrent health expenses in these institutions is consistent with the role in delivering medical care and with the key actor in offering preventive services.%目的 了解北京市基层医疗卫生机构经常性卫生费用筹集及消耗情况,为卫生政策的制定提供依据.方法 2016年7月—2017年6月,以卫生费用核算体系2011为基础,核算2015年北京市基层医疗卫生机构费用概况、筹资方案构成、服务功能流向(包括治疗服务费用分析和预防服务费用分析).其中卫生费用总量数据来源于中国统计年鉴2016、北京统计年鉴2016、北京市政府卫生投入监测系统、北京市公共卫生信息中心、2015年北京市卫生总费用核算报告等;分摊系数通过北京市卫生医疗价格监测数据平台的个案库以及医疗卫生机构抽样调查数据计算得到.结果 2015年北京市基层医疗卫生机构经常性卫生费用为138.11亿元,其筹资方案以社会医疗保险方案、政府方案为主(占比分别为56.14%、27.20%).2015年北京市基层医疗卫生机构仅提供治疗服务和预防服务,其费用占比分别为86.96%、13.04%.2015年北京市基层医疗卫生机构的治疗服务费用按全球疾病负担(GBD)分类,主要由慢性非传染性疾病消耗(占比为70.90%);按国际疾病分类(ICD-10)标准分类,主要由循环系统疾病消耗(占比为25.88%);按年龄段分类,其主要由50~69岁患者消耗(占比为58.05%).2015年北京市基层医疗卫生机构预防服务费用以免疫规划(占比为24.86%)、慢病防治(占比为13.33%)、老年人健康管理(占比为10.37%)、居民健康档案管理(占比为10.05%)为主.结论 公共筹资方案在北京市基层医疗卫生机构卫生筹资中起主导作用;经常性卫生费用核算结果与基层医疗卫生机构的治疗服务功能定位相符;基层医疗卫生机构是北京市预防服务的主要提供机构之一.