作　　者： (何亚盛）; (章湖洋）; (景日泽）; (徐婷婷）; (高珊）; (方海）;

机构地区： 北京大学公共卫生学院,1北京10019l

出　　处： 《中国卫生经济》 2017年第9期35-38,共4页

摘　　要： 目的:分析总额预付实施前后北京市二三级医院运行状况的变化,探讨总额预付对不同级别的医院影响的差异,从而评价总额预付的实施效果,发现存在的问题并提出建议。方法:使用"北京市卫生工作统计资料汇编"2007—2014年的数据,采用描述性统计和固定效应模型进行分析。结果:总额预付有效控制了二三级医院的药占比且对三级医院的次均费用控制效果优于二级医院,但是难以控制三级医院的服务量;固定效应模型显示总额预付能控制二级医院的业务收入,但是对三级医院业务收入没有影响。结论:总额预付取得一定效果,但是难以控制三级医院院均业务收入,应该切实推行分级诊疗并精细化测算总额预付基金数额。 Objective： To analyze the changes of the operation status of the secondary and tertiary hospitals in Beijing after the im- plementing the global budget of medical insurance, and to explore the efiect of the global budget on different levels of hospitals, find problems anti make recommendations. Methods： The descriptive statistics and fixed effect models were emph）yed to analyze the data came from Beijing Health Work Statistics Colte（;tion （2007-2014）. Results： ＂rile global budget of medical insurance effectively （＇~on- trolled the drug revenues proportion and the average cost of secondary and tertian： hospitals. Meanwhile, the cost enntrol eff~（,ts of ter- tiary hospitals were better than seeon（lal7 hospitals, but it was difficu]l to control service volumes of tertiary hospitals. The fixed effect model showed that the global budget of medical insurance could control the secondary hospital service revenues, but had no effect on the tertiary hospital service revenues. Conclusion： The global budget of medical insurance had certain positive effects on hospital per- formances in Beijing, but it was difficult to control tertiary hospital serviee revenues. It needed to promole hierarchical medical system and calculate the amounts of global budget carefully.

关 键 词： 二三级医院 医疗保险 总额预付 效果评价 北京