县域医共体对新农合参合居民就诊流向的影响分析——以安徽省定远县为例

摘要

Objective:This study is conducted to analyze the impact of county medical alliance on patient flows under the NRCMS in Dingyuan county of Anhui province. Methods: data on patient-flow were collected through the NRCMS information platform and related policy documents for 2015-2016, and interviews were conducted to study the main reform practices in the county medical alliance. Results: The patient flow under the NRCMS varied in the way of 1) the total number of inpatients seeking treatment outside of the county decreased by 3.31%;2) the treat-ment volume of county-level hospitals and township health centers were increasing,and the latter one is growing faster than the former,meanwhile,the treatment volume of the village clinics declined,and 3) the hospitalization expenses per inpatient for patients who seek treatment outside the county are much higher than the expenses incurred within the county. Conclusions:the development of county-level medical alliance has influence on patients with common disea-ses who used to seek treatment by helping to reduce the number of inpatients outside the county and reduce the pres-sure of the new rural cooperative fund. However, significant problems still exist such as shortage of talented practi-tioners,and lagging development of information technology system.%目的:分析安徽省定远县开展县域医共体建设对新农合参合居民就诊流向的影响.方法:开展访谈了解县域医共体主要改革举措,收集2015-2016年新农合平台数据及相关政策文件.结果:2015-2016年参合人员就诊流向发生改变;(1)县域外住院病人减少了3.31%;(2)县域内县乡两级医疗机构门诊、住院人次显著增加,且乡镇卫生院住院人次数增长幅度大于县级医院;村卫生室诊疗人次数下降.3)县域外诊疗费用远高于县域内,且县级医院次均费用增长明显,而乡镇卫生院基本保持不变.结论:县域医共体建设有助于减少县域外住院人次数、减轻新农合基金压力;进一步改善县域就诊流向面临人才短缺、信息化发展滞后等挑战.