基于时间序列的按人头支付对住院医疗费用的影响分析

目的:分析按人头支付政策干预对参合对象住院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住院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住院医疗费用的影响。结果:政策干预后40个月参合对象的实际次均住院费用(11 176.95元)较干预前20个月(8 279.66元)增加了34.99%;按人头支付政策干预后,次均住院费用的模型预测值(12 836.63元)明显高于实际值(P0.001);同时,简单季节模型结果显示,同期参合对象的实际住院人次与预测值基本持平(P0.05)。结论:按人头支付政策干预实施3年多来,有效遏制了住院患者医疗费用的过快增长,但未抑制住院服务需求的合理释放。

Time Series Analysis of the Effect on In patient Cost in C apitation Payment Reform

Object: To evaluate the effect of inpatient cost under the background of the capitation payment reform in new rural cooperative medical system (NCMS). Methods: We performed retrospective time series analysis of the inpatient cost in NCMS fund by analyzing monthly data in Pudong New Area from the year of 2011 to the year of 2015. Results: In 40 months after the policy intervention, the mean insured inpatient cost per visit (RMB 11176.95) was increased by 34.99% than 20 months before (RMB 8279.66). The mean forecasted inpatient cost per visit (RMB 12836.63) was higher than observed values ( P<0.001). And it was statistically the same between the observed and forecasted number of inpatients of the corresponding period by simple seasonal model (P>0.05). Conclusion: In over 3 years after the policy intervention in NCMS, it was effective in cost curb of expenses excessive growth for inpatients, and d id not inhibit the normal release of their medical service demand.