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山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (8): 120-126.doi: 10.6040/j.issn.1671-7554.0.2022.0274

• 公共卫生与管理学 • 上一篇    下一篇

山东省医共体试点医保基金使用情况分析

单莹1,2,赵洋1,2,李程1,2,李士雪1,2   

  1. 1.山东大学齐鲁医学院公共卫生学院卫生管理与政策研究中心, 山东 济南 250012;2.国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学), 山东 济南 250012
  • 发布日期:2022-07-27
  • 通讯作者: 李士雪. E-mail:shixueli@sdu.edu.cn

Analysis on use of medical insurance fund of compact medical community in Shandong Province

SHAN Ying1,2, ZHAO Yang1,2, LI Cheng1,2, LI Shixue1,2   

  1. 1. Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    2. NHC Key Lab of Health Economics and Policy Research(Shandong University), Jinan 250012, Shandong, China
  • Published:2022-07-27

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摘要： 目的 基于时空视角分析山东省紧密型医共体试点医保基金使用情况。 方法 依据卫健委医共体试点信息监测平台数据,运用医保基金支出、医保基金流向、门诊费用、住院费用等方面相关指标,对山东省医共体试点医保基金使用情况进行描述性分析、对比分析等。 结果 2018~2020年山东省医共体试点医保基金总支出逐年增加,县域内支出率有所提升,基层支出仍占比较低且呈下降趋势;门诊均次费用逐年上升,住院均次费用则有所下降;地区间发展不均衡,东部地区较中部、西部优势明显。 结论 建议探索建立科学合理的医保基金支付机制,推动分级诊疗落实;加速推动医保支付方式改革,切实降低患者个人负担;明确政府主导作用,加强统筹规划,促进地区间均衡发展。

关键词: 紧密型县域医共体, 医保支付方式, 医保基金, 山东

Abstract: Objective To analyze the use of medical insurance fund of compact medical community in Shandong Province based on time and space perspective. Methods Based on data from the Medical Community Pilot Information Monitoring Platform of the Health Commission, and with medical insurance fund expenditures, medical insurance fund flow, outpatient expenses and hospitalization expenses as indicators, descriptive analysisand comparative analysis were conducted on the use of pilot medical insurance fund. Results From 2018 to 2020, the total expenditure increased year by year, the expenditure rate within counties increased, and the grassroots expenditure accounted for a relatively low and declining trend. The average outpatient expenditure increased year by year, but the average hospitalized expenses decreased. The development of regions was uneven, and the eastern regions had obvious advantages over the central and western regions. Conclusion A scientific and reasonable medical insurance fund payment mechanism should be established to promote the implementation of hierarchical diagnosis and treatment. The reform of medical insurance payment methods should be accelerated to reduce the personal burden of patients effectively. The leading role of government should be clarified to strengthen the overall planning and balanced development among regions.

Key words: Merged county medical alliance, Medical insurance payment method, Medical insurance fund, Shandong

中图分类号: 

  • R197.1
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