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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 operational status of Grade II and III hospitals in Beijing before and after the implementation of the total prepayment, and to explore the differences in the impact of total prepayment on different levels of hospitals so as to evaluate the implementation effect of the total prepayments and find out the problems and make recommendations. Methods: Using the data of Beijing Health Work Statistics Collection 2007-2014, we use descriptive statistics and fixed effects model to analyze. Results: The total prepayment effectively controlled the proportion of medicine in Tier-3 and Tier-3 hospitals, and the control effect on the average cost of Tier-3 hospitals was better than that of Tier 2 hospitals, but it was difficult to control the Tier-3 hospitals. The fixed-effects model showed that total prepayments could control Second-tier hospital business income, but has no effect on tertiary hospital business income. Conclusion: The total prepayment achieved some results, but it is difficult to control the tertiary hospital hospital average business income, it should effectively promote the grading diagnosis and treatment and refine the total estimated amount of advance fund.