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目的:分析按人头支付政策干预对参合对象门诊服务利用的相关影响。方法:收集2011—2015年浦东新区按人头支付干预前后新型农村合作医疗参合对象门诊服务利用相关数据,通过比较分析,评价政策干预对参合对象门诊服务利用的影响。结果:80%的门诊服务利用发生在社区卫生服务机构,16%发生在二级医院;从费用来看,社区卫生服务机构和二三级医疗机构的门诊医疗费用各占一半;从环比增速来看,按人头支付政策干预后患者的次均门诊费用呈逐年下降的趋势,2015年二三级医疗机构参合对象次均门诊费用分别为275.46元和208.24元。结论:参合对象的总体门诊服务利用次数和费用均逐年增加,二三级医疗机构就诊增加明显;政策干预后对参合对象次均门诊费用控制较好,尤其二三级医院下降明显。
OBJECTIVE: To analyze the relative impact of policy interventions on the utilization of outpatient services in participating countries. Methods: The data of outpatient service utilization in new rural cooperative medical care before and after the intervention in Pudong New Area from 2011 to 2015 were collected, and the impact of policy intervention on outpatient service utilization was evaluated through comparative analysis. Results: 80% outpatient service utilization took place in community health service agencies and 16% occurred in second level hospitals. From the perspective of cost, outpatient medical expenses of community health service institutions and second and third level medical institutions each accounted for half; From the point of view of payment policy, the average outpatient cost per patient dropped year by year. In 2015, the average outpatient expense for the second and third level medical institutions was 275.46 yuan and 208.24 yuan respectively. Conclusion: The number and cost of outpatient services for participating clients increased year by year, and the number of visits to second and third level medical institutions increased significantly. After the policy intervention, the outpatient cost of participating hospitals was better controlled, especially for second and third level hospitals.