[1]樊 淼,李之淳,杜金芮,等.县域医共体医保总额付费效果研究[J].卫生经济研究,2025,42(01):48-51.
　FAN Miao,LI Zhichun,DU Jinrui,et al.Study on the Effect of Global Budget of Medical Insurance in County-level Medical Community[J].Journal Press of Health Economics Research,2025,42(01):48-51.
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县域医共体医保总额付费效果研究
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
42
期数:
2025年01期
页码:
48-51
栏目:
改革探索
出版日期:
2025-01-07

文章信息/Info

Title:
Study on the Effect of Global Budget of Medical Insurance in County-level Medical Community
作者:
樊 淼1; 李之淳1; 杜金芮1; 孙玉凤1
1.宁夏医科大学人文与管理学院，宁夏 银川 750004
Author(s):
FAN Miao;  LI Zhichun;  DU Jinrui;  SUN Yufeng
Humanities and Management College, Ningxia Medical University, Yinchuan Ningxia 750004, China
关键词:
县域医共体; 医保支付方式; 双重差分法; 总额付费
Keywords:
county medical community;  medical insurance payment method;  double difference method;  global budget
分类号:
R19
文献标志码:
A
摘要:
目的：评价县域医共体实施医保总额付费的政策效果，为推动医疗保险与县域医共体的联动改革提供参考。方法：运用双重差分法，从医疗费用、分级诊疗、医疗质量、医保支出、个人负担五个层面评价县域医共体医保总额付费的效果。结果：与非试点地区相比，试点地区医共体的次均门诊费用和医疗费用自付比例分别降低了15.141元和8.819个百分点，门诊医保基金支出比例和下转转诊率分别提高了12.419个百分点和1.539个百分点。结论：县域医共体开展医保总额付费能够提升患者控费意识，减轻患者疾病经济负担，促进医保基金有效使用，推动分级诊疗制度发展；但也存在改革进展滞后于医共体发展的困境，需因地制宜，完善县域医共体医保支付方式，建立与其适应的配套政策。
Abstract:
Objective To evaluate the policy effect of global budget of medical insurance in county-level medical community, and to provide reference for further promoting the linkage reform of medical insurance and county-level medical community. Methods The double difference method was used to evaluate the effect of global budget of medical insurance in county-level medical community from five aspects of medical expenses, hierarchical diagnosis and treatment, medical quality, medical insurance expenditure and personal burden. Results Compared with the non-pilot medical community areas, the average outpatient expenses and the proportion of out-of-pocket medical expenses in the pilot areas decreased by 15.141 yuan and 8.819 percentage points respectively, while the proportion of outpatient medical insurance fund expenditure and the downward referral rate increased by 12.419 percentage points and 1.539 percentage points respectively. Conclusion The implementation of global budget of medical insurance in county-level medical community has a positive effect on improving patients ' awareness of cost control, reducing the economic burden of patients' illnesses, promoting the effective use of medical insurance funds, and promoting the development of the hierarchical diagnosis and treatment system. However, there is also the dilemma that the progress of the reform is lagging behind the development of the medical communities. It is necessary to improve the payment method of medical insurance in county-level medical community and establish the supporting policies in accordance with the local conditions.

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更新日期/Last Update: 2025-01-07