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目的评估医保总额预算制的实施对医保支出及医疗行为的影响。方法收集我院2009—2015年的医保相关数据,并从全院和科室两个维度分别分析,为医院及各科室提供参考;通过医患问卷调查及关键知情人访谈,了解改革对医疗行为和管理产生的影响。结果门诊患者人次人头比有上升倾向,住院患者改变不明显,而次均费用自总额预算制实施后呈缓慢递减趋势;大部分医患对改革持满意态度,但对配药限制政策存在不满,同时该制度实施过程中在指标科学性、信息透明度等方面存在不足。结论医保总额预算制会影响医院管理行为,是控制医疗费用的有效办法,但在配药限制政策、医保指标科学性、信息透明度等方面仍需进一步改进。
Objective To assess the impact of the implementation of the health insurance budget system on health insurance expenditures and medical practices. Methods The data of medical insurance in our hospital from 2009 to 2015 were collected and analyzed from the two dimensions of hospital and department to provide references for hospitals and departments. Through questionnaire survey of doctors and patients and interviews with key insiders, The impact of management. Results The head-to-head outpatient population tended to rise and the inpatients did not change significantly. However, the average per capita cost tended to decrease slowly since the implementation of the total budget system. Most of the patients were satisfied with the reform but were dissatisfied with the drug restriction policy. Meanwhile, The implementation of the system in the index of scientific nature, lack of transparency and other aspects of information. Conclusion The budget system of medical insurance will affect the hospital management behavior, which is an effective way to control the medical expenses. However, it still needs to be further improved in terms of the drug restriction policy, scientific index of medical insurance and information transparency.