医保综合支付方式改革引导医疗行为改变的实证分析

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目的:对比平谷区新型农村合作医疗葡萄相关指标,评估平谷区新型农村合作医疗综合支付方式改革引导医疗行为改变的效果。方法:对平谷区医院相关DRGs指标以及基层住院和试点乡镇门诊相关数据进行比较。结果:急症短期住院费用增长得到控制、药占比等下降;基层医疗机构不必要住院大幅降低、基层门诊回流。结论:北京市平谷区采用急症短期住院按诊断相关组(DRGs)、慢病长期住院按床日和与签约服务相结合的门诊按人头付费的新型农村合作医疗综合支付方式改革试点数据显示,医院工作效率提高并可获得相应控费激励性收益,体现了医保支付方式有效引导医疗行为的效果。 OBJECTIVE: To compare the new grapevine-related indicators of rural cooperative medical care in Pinggu District and evaluate the effect of the reform of comprehensive payment of new rural cooperative medical system in Pinggu District. Methods: The Pinggu District hospital DRGs indicators as well as primary hospital and pilot township clinics data were compared. Results: Short-term hospitalization costs were controlled and the proportion of medicine dropped. Primary care institutions did not need hospitalization drastically and grassroots clinics returned. Conclusion: The experimental data of reforming the new rural cooperative medical care comprehensive payment system based on emergency short-term hospitalized diagnosis-related groups (DRGs), chronic long-term hospitalized bed days and paid outpatient services combining with contract services in Pinggu District of Beijing showed that hospitals Work efficiency and access to the corresponding control incentive income, reflects the health insurance payment effectively guide the effect of medical behavior.
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