健康绩效评估建模及其对中国紧的医疗社区的应用
Miao Yu1, Zhongmou Huang2, Dan Zhang2
1Institute for Hospital Management Tsinghua University Beijing China.
Health care science
|September 2, 2024
概括
中国医疗保险需要准确的健康风险评估工具. 一个新的模型显示了一个紧的医疗社区.
科学领域:
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
- 医疗保险管理 医疗保险管理
背景情况:
- 中国实施医疗保险基金的资本支付和预算管理.
- 目前缺乏用于量化人口健康风险的工具.
- 需要改善医疗保健系统的健康绩效评估.
研究的目的:
- 构建和验证健康绩效评估模型.
- 将参与者分类为健康风险组.
- 为当地金融和医疗保险局提供激励计划的信息.
主要方法:
- 将参与者分为健康风险组的分类 (家庭医生合同,年龄,性别,咨询类型).
- 基于医疗保健资源利用的群体分层.
- 对医疗保健资源利用和成本的年比年分析.
- 从2019-2021年对一个紧的医疗社区的健康表现的评估.
主要成果:
- 根据成本权重将健康风险组分为六个类别.
- 分析显示,严重/超严重疾病患者和相关成本 (2019-2021) 的增加.
- 资源使用和费用的比例转移到高风险患者类别.
结论:
- 在被研究的社区中,人口的整体健康状况没有得到改善.
- 医学界仍然专注于疾病治疗,忽视了健康维护.
- 健康表现的最小改善表明需要修订战略.
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