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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
[1] 国家卫生健康委员会,中医药管理局.关于推进紧密型县域医疗卫生共同体建设的通知[EB/OL].(2019-05-28)[2021-12-01]. http://wwwnhcgovcn/jws/s3580/201905/833cd709c8d346d79dcd774fe81f9d83shtml.
[2] Sonymol K, Shankar Ravi. Healthcare cost reduction and health insurance policy improvement [J]. Value in Health Regional Issues, 2022, 29. doi: 10.1016/J.VHRI.2021.10.001.
[3] 陈雯, 李锦汤, 李萍. 广东省阳西县紧密型县域医共体医保支付方式改革分析评价[J]. 中国医疗保险, 2021, 10(10): 51-55. CHEN Wen, LI Jintang, LI Ping. Analysis and evaluation on the medical insurance payment mode reform of compact county medical service community in Yangxi [J]. China Health Insurance, 2021, 10(10): 51-55.
[4] 张敏, 张淑娥, 时宇, 等. 基于清晰集定性比较分析的地方政府县域医共体创新实践影响因素及其组合路径分析[J]. 中国全科医学, 2022, 25(10): 1254-1260. ZHANG Min, ZHANG Shue, SHI Yu, et al. Influencing factors and path combination of county medical community innovation by local government: a crisp set qualitative comparative analysis [J]. Chinese General Practice, 2022, 25(10): 1254-1260.
[5] 郁建兴, 涂怡欣, 吴超. 探索整合型医疗卫生服务体系的中国方案—基于安徽、山西与浙江县域医共体的调查[J]. 治理研究, 2020, 36(1): 5-15.
[6] 单莹, 孔凡磊, 刘广文, 等. 时空视角下山东省疾病预防控制机构经济运行现状分析[J].中国卫生经济, 2021, 40(9): 81-85. SHAN Ying, KONG Fanlei, LIU Guangwen, et al. Analysis on the economics operation of Shandong disease prevention and control institutions based on time and space perspective [J]. Chinese Health Economics, 2021, 40(9): 81-85.
[7] 谢岱仪, 王前. 广州市某三甲医院两种医保支付方式住院费用比较与控费探讨[J]. 医学与社会, 2017, 30(10): 41-43. XIE Daiyi, WANG Qian. Discuss of comparison of hospitalization expenses and costs control of two payment methods of a level three grade a hospital in Guangzhou City [J]. Medicine and Society, 2017, 30(10): 41-43.
[8] 胡晓先. 从城乡居民医保住院费用流向看紧密型县域医共体的建设[J]. 中国农村卫生事业管理, 2020, 40(2): 106-108. HU Xiaoxian. On the construction of tight county medical community from the flow of medical insurance and hospitalization expenses of urban and rural residents [J]. Chinese Rural Health Service Administration, 2020, 40(2): 106-108.
[9] 谭敏, 陈迎春, 张研, 等. 基于Agent建模仿真医保政策调整对北京市高血压住院患者就医选择和医保基金流向的影响[J]. 中国卫生经济, 2019, 38(2): 17-20. TAN Min, CHEN Yingchun, ZHANG Yan, et al. Effects of the basic medical insurance policy for residents on hypertensive inpatients medical services seeking behaviors and medical insurance fund flow in Beijing based on multi-agent modeling simulation [J]. Chinese Health Economics, 2019, 38(2): 17-20.
[10] 胡克, 吴亚飞, 韩耀风, 等. 空间统计方法在期望寿命研究中的应用进展[J]. 中国卫生统计, 2020, 37(5): 783-786.
[11] 佘凯丽, 张丹丹, 齐畅, 等. 安徽省新型冠状病毒肺炎流行病学特征及其潜伏期估计[J].山东大学学报(医学版), 2020, 58(10): 44-52. SHE Kaili, ZHANG Dandan, QI Chang, et al. Epidemiological characteristics and incubation period of coronavirus disease 2019 in Anhui Province[J]. Journal of Shandong University(Health Science), 2020, 58(10): 44-52.
[12] 崔兆涵, 王虎峰. 整体性治理视角下紧密型医共体的构建逻辑与实施路径[J]. 中国卫生政策研究, 2021, 14(2): 1-7. CUI Zhaohan, WANG Hufeng. The construction logic and implementation path of the merged county medical community from the perspective of holistic governance [J]. Chinese Journal of Health Policy, 2021, 14(2): 1-7.
[13] 戴悦, 尚钊, 薛冬羽, 等. 紧密型县域医共体政府监管的问题探析和对策研究[J]. 南京医科大学学报(社会科学版), 2022, 22(1): 20-24. DAI Yue, SHANG Zhao, XUE Dongyu, et al. Problems and solutions of medical alliances regulatory: an analysis based on the Smith model [J]. Journal of Nanjing Medical University(Social Sciences), 2022, 22(1): 20-24.
[14] 陆增辉, 陈艳宁, 黄二丹, 等. 基于聚类分析的全国医共体试点县分类指导方法与实践[J]. 中国卫生经济, 2022, 41(2): 39-43. LI Zneghui, CHEN Yanning, HUANG Erdan, et al. Classification and practice of pilot counties in Chinas medical community based on cluster analysis [J]. Chinese Health Economics, 2022, 41(2): 39-43.
[15] 光心慧, 王珩, 薛俊军, 等. 基于米特—霍恩模型的紧密型县域医共体运行困境研究[J].南京医科大学学报(社会科学版), 2021, 21(6): 533-537. GUANG Xinhui, WANG Heng, XUE Junjun, et al. Research on the operational dilemma of compact county medical alliances based on the Meter-Horn model [J]. Journal of Nanjing Medical University(Social Sciences), 2021, 21(6): 533-537.
[16] 廖冬平. 医共体下医保打包支付与C-DRG的实践探索[J]. 中国卫生经济, 2022, 41(1): 49-52. LIAO Dongping. The practice of medical insurance package payment and C-DRG under medical alliance [J]. Chinese Health Economics, 2022, 41(1): 49-52.
[17] 宋生来, 胡小波, 胡晓彦. 湖州市医共体综合付费方式改革的经验和启示—以德清县为例[J]. 卫生经济研究, 2021, 38(12): 25-28. SONG Laisheng, HU Xiaobo, HU Xiaoyan. Experience and enlightenment of comprehensive payment method reform in Huzhou medical alliance [J]. Health Economics Research, 2021, 38(12): 25-28.
[18] 江刚, 赵允伍, 王晓松, 等. 我国整合型医疗卫生服务体系构建策略探讨[J]. 南京医科大学学报(社会科学版), 2021, 21(5): 413-417. JIANG Gang, ZHAO Yunwu, WANG Xiaosong, et al. Discussion on the construction strategy of the integrated delivery systems in China [J]. Journal of Nanjing Medical University(Social Sciences), 2021, 21(5): 413-417.
[19] 巫蓉, 朱亚, 屠小明, 等. 国内外促进分级诊疗的实践经验及启示[J]. 南京医科大学学报(社会科学版), 2018, 18(3): 172-175. WU Rong, ZHU Ya, TU Xiaoming, et al. Practice and revelation of hierarchical diagnosis and treatment at home and abroad [J]. Journal of Nanjing Medical University(Social Sciences), 2018, 18(3): 172-175.
[20] 万彬, 胡大洋, 张蔚, 等. 医药医保政策改革下的江苏省医保基金运行绩效研究[J]. 中国卫生经济, 2020, 39(4): 36-39. WANG Bing, HU Dayang, ZHANG Wei, et al. Study on the Operation Performance of Medical Insurance Funds in Jiangsu under the Medical and Drug Insurance Policy Reform [J]. Chinese Health Economics, 2020, 39(4): 6-39.
[21] 万彬, 程向前, 陈蕾, 等. 镇江市医保基金医疗服务支付方式控费现状研究[J]. 南医大学报, 2013(4): 292-297. WAN Bing, CHENG Xiangqian, CHEN Lei, et al. An investigation of medical service cost control of medical insurance fund in Zhenjiang [J]. Journal of Nanjing Medical University(Social Sciences), 2013(4): 292-297.
[22] 林江洪. 医保支付方式改革对控制医药费用不合理增长效果研究[J]. 科技风, 2019, 378(10): 212.
[23] 王力男, 朱碧帆, 胡善联. 城市区级医联体医保总额付费基金测算方法探索[J]. 中国卫生经济, 2018, 37(11): 20-23. WANG Linan, ZHU Bifan, HU Shanlian. Research on the budgeting measurement for the basic medical insurance in urban district medical union [J]. Chinese Health Economics, 2018, 37(11): 20-23.
[24] 刘蓉. 医保付费制度改革及医保总额预付的精细化管理研究[J]. 中国卫生产业, 2019, 16(19): 2.
[25] 周倩, 鞠珂, 赵晓恒, 等. 我国紧密型县域医共体典型模式比较及实现条件分析—基于“三圈理论”视角[J].卫生软科学, 2022, 36(1): 12-16. ZHOU Jing, JU Ke, ZHAO Xiaoheng, et al. Analysis on the comparison of medical alliance typical models in close-type counties and its realization condition—Based on “three circles theory” [J]. Soft Science of Health, 2022, 36(1): 12-16.
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