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预防医学  2017, Vol. 29 Issue (10): 999-1002    DOI: 10.19485/j.cnki.issn1007-0931.2017.10.007
  论著 本期目录 | 过刊浏览 | 高级检索 |
社区签约服务对分级诊疗影响的研究
陈 芳1,何晓燕1,徐钦芳2
1. 杭州市疾病预防控制中心,浙江 杭州  310021;
2. 杭州市卫生和计划生育委员会
A study on the influence of medical insurance paying proportion to hierarchical diagnosis and treatment
CHEN Jun-fang,HE Xiao-yan,XU Qin-fang
The Center for Disease Control and Prevention of Hangzhou City,Hangzhou,Zhejiang,310021,China
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摘要 目的 分析社区签约服务对分级诊疗的影响,为完善分级诊疗制度提供依据。方法 从杭州市医疗保险信息管理数据库中导出2015年杭州市基本医疗保险参保居民的就诊资料,分析不同医保类型参保人群在社区卫生服务机构就诊率,并按照是否签约家庭医生和年龄进行分层分析。结果 截至2015年底杭州市主城区职工医保和城乡居民医保参保人数分别为288.99万人和17.41万人,家庭医生签约率分别为13.19%和50.89%。城乡居民医保参保人群社区卫生服务机构就诊率为77.22%,高于职工医保参保人群的51.26%(P<0.01)。职工医保参保人群中,签约对象社区卫生服务机构标化就诊率为55.06%,高于非签约对象的44.49%;城乡居民医保参保人群中,签约对象社区卫生服务机构标化就诊率为73.30%,低于非签约对象的80.98%。结论 是否签约家庭医生是社区卫生服务机构就诊的影响因素,提升职工医保参保人群家庭医生签约率,可进一步推动杭州市居民分级诊疗制度的构建与实施。
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陈芳
何晓燕
徐钦芳
关键词 医疗保险统筹比例分级诊疗家庭医生签约    
AbstractObjective To analyze the influence of medical insurance paying proportion to hierarchical diagnosis and treatment,and to provide basis for the improvement of hierarchical diagnosis and treatment. Methods Data about average number of visits of insured residents in 2015 were obtained from Hangzhou medical insurance service database. Differences between visits to Community Health Service Centers (CHSC) of residents having Medical Insurance of Urban and Rural Residents(MIURR)and residents having Urban Employees' Basic Medical Insurance(UEBMI)were compared. And differences stratified by signed contracted services offered by General Practitioners(GPs)or not were further analyzed. Results Proportion of visits to CHSCs in all visits to medical institutions in residents with MIURR was 77.22%,which was significantly higher than the proportion in residents with UEBMI was 51.26%. In the residents with UEBMI,and the proportion of visits to CHSCs in all visits to medical institutions of the group sighed contracted services offered by GPs was significantly higher than the group non-sighed. Conclusion Increasing the gap between reimbursement ratio of CHSCs and higher medical institutions plays an important role in guiding health-seeking behavior of residents. Reformation of medical insurance payment and contracted services will guide residents to seek medical treatment and effective referral.
Key wordsMedical insurance    Pooling funds payment proportion    Hierarchical diagnosis and treatment    Effects evaluation
收稿日期: 2017-02-27      出版日期: 2017-10-10
ZTFLH:  R197.1  
基金资助:杭州市科技发展计划项目(20150834M25);杭州市卫生科技计划(一般)项目(2015A50)
通信作者: 陈芳,E-mail:cjf_wang@163.com   
作者简介: 陈芳,本科,副主任医师,主要从事公共卫生管理与慢性病预防控制工作
引用本文:   
陈芳,何晓燕,徐钦芳. 社区签约服务对分级诊疗影响的研究[J]. 预防医学, 2017, 29(10): 999-1002.
CHEN Jun-fang,HE Xiao-yan,XU Qin-fang. A study on the influence of medical insurance paying proportion to hierarchical diagnosis and treatment. Preventive Medicine, 2017, 29(10): 999-1002.
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http://www.zjyfyxzz.com/CN/10.19485/j.cnki.issn1007-0931.2017.10.007      或      http://www.zjyfyxzz.com/CN/Y2017/V29/I10/999
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