铁路医疗保障制度改革对铁路医院病床工作效率的影响

目的探讨铁路医疗保障制度改革对铁路医院经营以及医疗工作的影响.方法运用质量控制图,对铁路职工医疗保障制度改革前后,某铁路中心医院病床工作效率指标变动情况进行分析.结果2004年2月铁路医疗保障制度启动,病人选择性就医的自由度加大,病人的卫生服务有效需求发生了转移,一部分铁路医保病人流向了有较强竞争力的其他医院,使得医院病床工作效率值骤然下降,低于病床工作效率控制下限;此后,铁路系统内病人外流造成的床位"空缺"逐渐被医院服务半径内的其他病人占用,医院病床工作效率逐渐缓慢回升,至2005年5月已接近医改前病床工作效率值平均水平.结论医保付费模式对医疗机构的内部管理提出了更高要求,铁路医院要在医疗制度改革的激烈医疗市场竞争中立于不败之地,应规范医疗行为,做到合理检查,合理治疗、合理用药.同时,定期考核医保规章制度执行情况,实施医疗费用公示,开展循证医学实践,主动适应并积极应对医疗市场的竞争,才能在改革的大潮中立于不败之地.

Effects of the Railroad Medical Security System Reform on the Railroad Hospital Bed Efficiency

Objective To explore the effects of the railroad medical security system reform on railroad hospital management and curative activity. Methods A railroad hospital bed efficiency index before and after the railroad medical security system reform was analyzed through applying the method of quality control chart. Results After the beginning of the railroad medical security systems reform at the Feb. 2004, the freedom of patients in the selecting hospital increased, the effectual demand of health service changed, and part railroader patients turn to other hospitals with more competitive ability so that railroad hospital bed efficiency index descend suddenly even lower than the lower control limit. After this, the hospital bed vacancy caused by the outflow of patients was occupied by nearby patients in the radius of hospital service gradually and the railroad hospital bed efficiency ascended correspondingly. The hospital bed efficiency got close the average level up to that of May 2005. Conclusion The payment mode of the medical security system claims higher requirement to interior management of medical institutions. Railroad hospitals intended to keep the invincible positioning in the tide of reform must standardize medical proceeding, make the rational use of auxiliary examinations, treatments and medicines, check the regulations of medical care assurance periodically, display the medical cost publicly, and put evidence - based medicine into practice, and actively adapt to and initiatively cope with the health market competition.