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目的:分析按人头支付政策干预对参合对象门诊医疗费用的相关影响。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门诊患者医疗费用相关数据,通过时间序列分析方法,评价政策干预对参合对象门诊医疗费用的影响。结果:政策干预后40个月参合对象的实际次均门诊费用(90.37元)较干预前20个月(84.98元)增加了6.34%;Holt-winters加法模型结果显示,按人头支付政策干预后,次均门诊费用的模型预测值(102.00元)明显高于实际值(P<0.001);同时简单季节模型结果显示,同期参合对象的实际门诊人次与预测值间差值无统计学差异(P>0.05)。结论:按人头支付政策干预3年多来,对控制参合对象次均门诊费用效果显著,在控费的同时未抑制门诊需求的正常释放。
OBJECTIVE: To analyze the relative impact of intervention by head-to-head payment on outpatient medical costs for participating patients. Methods: The data of medical expenses of new rural cooperative medical clinic patients paid before and after the intervention in Pudong New Area from 2011 to 2015 were collected. The influence of policy intervention on the outpatient medical expenses of the participating objects was evaluated through time series analysis. Results: The actual outpatient outpatient expense (90.37 yuan) for the 40 months after policy intervention was 6.34% higher than that of the first 20 months (84.98 yuan) before the intervention. The results of the Holt-winters addition model showed that after intervention by the head payment policy, The predictive value of the average outpatient cost (102.00 yuan) was significantly higher than the actual value (P <0.001). Meanwhile, the results of the simple seasonal model showed that there was no significant difference between the actual outpatient attendance and the predicted value (P> 0.05). CONCLUSION: According to the intervention policy of head payment policy for more than three years, the effect of controlling outpatients’ cost of outpatient visits is remarkable. In addition, the control fee does not inhibit the normal release of outpatient needs.