PDF(Pubmed)
Abstract：
Hierarchical diagnosis and treatment (HDT) is an important exploration direction to alleviate the rising pressure of health expenses and medical insurance fund expenditure in China, and to maintain and protect the public health in this country. In recent years, the construction of compact county medical communities (CCMC) has become the primary approach for implementing the HDT. Utilizing the quasi-natural experiment of the pilot project of CCMC in Sichuan Province in 2019, coupled with county-level data extracted from the \' Sichuan Provincial Health Statistics Yearbook \' spanning the years 2008 to 2021, this research evaluates the effect of the pilot project of CCMC on promoting HDT under the medical insurance package payment model. The results show that the pilot project of CCMC has significantly increased the number of consultations per capita of medical and health institutions in pilot counties by 0.434 times, of which the number of consultations per capita of primary medical institutions has increased by 0.340 times; the number of hospitalizations per capita in public hospitals and primary medical institutions in pilot counties increased significantly, and the surgery rate of inpatients in public hospitals increased by 5% compared to before the pilot. There was no significant impact on the allocation of medical facilities and human resources in the pilot counties. Therefore, the construction of CCMC under the medical insurance package payment mode has promoted the realization of the county-level HDT. These findings provide valuable insights for healthcare policy, especially in developing and implementing effective strategies for HDT in county-level medical institutions.
摘要：
分级诊疗(HDT)是缓解我国卫生费用和医保基金支出上涨压力的重要探索方向,维护和保护这个国家的公众健康。近年来,紧凑型县级医疗社区（CCMC）的建设已成为实施HDT的主要方法。本研究利用2019年四川省CCMC试点项目的准自然实验，结合从2008年至2021年的《四川省卫生统计年鉴》中提取的县级数据，评估了CCMC试点项目在医疗保险套餐支付模式下促进HDT的效果。结果显示,CCMC试点使试点县医疗卫生机构人均就诊人数显著提高0.434倍,其中基层医疗机构人均就诊人数增长0.340倍;试点县公立医院和基层医疗机构人均住院人数大幅增加,公立医院住院患者的手术率比试点前增加了5%。对试点县的医疗设施和人力资源配置没有显著影响。因此,医保套餐支付模式下CCMC的构建促进了县级HDT的实现。这些发现为医疗保健政策提供了有价值的见解，特别是在县级医疗机构制定和实施HDT有效策略方面。
