中国的医院改革是否改善了治疗护理支出? 来自北京医院的证据
Yan Jiang1, Zhaoran Han1, Stephen Nicholas2,3
1School of Management, Beijing University of Chinese Medicine, No.11 North 3rd Ring Road East, Chaoyang District, Beijing, China.
BMC health services research
|April 30, 2025
概括
北京 北京 北京 北京 北京
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 公共卫生 公共卫生
背景情况:
- 北京在2017年 (改革1) 和2019年 (改革2) 实施了全面的医疗保健改革.
- 这些改革旨在控制治疗护理支出 (CCE) 并改善医疗保健服务.
- 该研究评估了这些改革对CCE和相关指标的影响.
研究的目的:
- 评估北京2017年和2019年医疗保健改革的有效性.
- 分析治疗护理支出 (CCE) 和改革后患者负担的变化.
- 评估对北京等级医疗体系 (HMS) 的影响.
主要方法:
- 利用来自医院信息系统 (HIS) 的2016年1月至2019年12月的患者数据.
- 采用多阶段分层集群随机抽样数据收集.
- 应用中断时间序列分析 (ITSA) 来评估改革对CCE和患者成本的影响.
主要成果:
- 改革并没有制CCE的上趋势,但降低了药品和消费品价格.
- 患者负担的影响是混合的:门诊费用在三级医院上升 (改革1),而住院费用在某些情况下下降.
- 改革对等级医疗系统 (HMS) 的影响微不足道,并没有显著地将患者转移到初级医院.
结论:
- 改革成果部分与目标保持一致;尽管降价,但CCE趋势仍然存在.
- 需要对医疗服务的价格进行重大调整,以鼓励初级医院利用率.
- 建议加强初级医院的能力,并开展公众宣传活动,以加强等级医疗体系.
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