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目的设计一种新的区域新农合双向转诊各方利益分配模式,以推进区域新农合双向转诊守门人体制建设。方法采用文献法和区域卫生行政管理系统统计资料分析法,提出双向转诊相关各方的利益分配模式,并运用区域内2010年医院实际数据进行可行性测算。结果实例数据估算表明,该双向转诊利益分配模式具有普惠性。每年可节省社会总医疗费用2 996万元,节省新农合基金871万元,参加双向转诊的参合农民人均次减少医疗费用1 056元,三级医疗机构获让利42万元,乡镇卫生院增收1 150万元,责任医生年增加工资1 093元以上,顾问医生每转诊一例患者可获得62.5～580元。结论双向转诊的原动力为医疗机构上下级医生,区域新农合双向转诊利益分配模式的核心机制是医疗机构间的保本让利,建立参合农民和上下级医疗机构及其医生多赢的利益分配格局,可以推动区域新农合双向转诊守门人体制的建设。
Objective To design a new pattern of distribution of interests among all parties involved in new NCMS in the region so as to promote the system construction of the two-way referral gatekeeper in NCMS. Methods The method of literature and regional health administrative management system statistical data analysis was used to propose the benefit distribution model of the parties involved in bidirectional referral. The actual data of 2010 hospitals in the region were used to calculate the feasibility. The result of the example data estimation shows that the two-way transfer of interest distribution model is universal. The annual total social medical expenses can be saved 29.96 million yuan, saving 8.771 million yuan for the new rural cooperative medical fund, reducing the medical expenses per capita for participating farmers of 1 056 yuan for two-way referrals, winning 42 thousand yuan for tertiary medical institutions, township hospitals An additional income of 11.5 million yuan, annual increase of responsible doctors more than 1 093 yuan, consultant doctors referral of a case of patients receive 62.5 to 580 yuan. Conclusions The driving force behind the two-way referral is the doctor-physician in the medical institutions. The core mechanism of the regional NCMS bi-directional referral benefit distribution is the inter-bank guaranteed benefit, the establishment of the win-win distribution of benefits for the participating peasants, super-lower-level medical institutions and their doctors The pattern can promote the construction of a two-way referral gatekeeper system in the region.