目的：：对比青海省湟中县实施医疗联合体改革前后新农合住院患者县域内外流向和医疗费用变化情况，分析县域医疗联合体改革对新农合住院患者县内就诊率的影响，并探索影响的原因及途径。方法：利用湟中县2013年与2014年新农合住院患者数据，对患者的就诊流向、住院费用等指标进行分析，并对关键知情者进行访谈。结果：医疗联合体改革后，县外就诊的住院患者人数构成比降低了6．38%，县外就诊的住院总费用环比降低了22．13%，县内、外就诊的次均住院费用分别上涨20．69%、14．41%。结论：县域医疗联合体改革通过提高乡镇卫生院的服务能力，加大县乡村三级医疗机构之间的协同作用，增强了县域卫生体系的整体服务能力，有助于县外常见病和多发病的住院患者回流至县内。%Objective:After examining the changes in medical expenses and flows of hospitalized patients with-in and outside the county under the New Rural Cooperative Medical Scheme ( NRCMS ) before and after the imple-mentation of health care alliance reform, this paper analyzes the impacts of health care alliance reform on the visiting rate of NRCMS patients within the county and explores their causes and channels. Methods:This paper uses the hos-pitalization data of NRCMS patients in 2013 and 2014 collected from Huangzhong county Qinghai province and inter-views with key informants and analyzes the hospitalization expenses, visiting flows and other indicators of patients. Results:After starting health care alliance reform, the total number of hospitalized patients to seek treatment outside the county decreased by 6 . 38%, the total hospitalization expenses to seek treatment outside the county decreased by 22 . 13%, and the hospitalization expenses per inpatient day to seek treatment within and outside the county increased by 14. 41% and 20. 69% respectively. Conclusions: By improving service capabilities of township health centers and increasing synergies between county-township-village health institutions, the county health care alliance reform has suc-cessfully enhanced the service capabilities of health care systems in the whole county and reasonably helped patients with common diseases to be hospitalized outside the county and frequently hospitalized people to return back to the county.
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