三明市医联体内公立医院医疗费用增长的结构分析

目的:分析三明市医联体内公立医院医疗费用增长的结构现状和影响因素.方法:通过结构分解法(SDA)分解医疗费用,运用描述性分析、逐步回归分析卫生资源供给结构对医疗费用增长的结构差异.结果:卫生资源供给结构呈现以梅列区、三元区和永安市为中心聚集态势,医疗费用分布和资源配置结构匹配.2016年医联体建设后基层服务利用显著增加,占三明市诊疗的54.51%,双向转诊成效显著.医疗费用膨胀效应始终是住院费用增长的首要驱动因素(66.72%),但患者在不同层级医院就诊的流动效应有显著提升(30.83%),卫生资源供给结构影响费用增长的结构,其中,千人均卫生技术人员对医疗费用膨胀效应存在显著正向影响(β=0.661,P<0.000).结论:医联体建设对三明市医疗费用增长结构显现出初步引导作用,能够实现患者在不同层级医疗机构之间的流动,卫生资源供给结构与费用增长结构紧密相关.建议从供给总量和结构两方面进行深度改革,加大对偏远县区卫生资源服务体系建设.同时进一步推动医疗联合体内优质医疗资源下沉,实现优势互补、资源共享,引导医疗费用的合理增长.

Structural Analysis of the Increase in Medical Expenses of Public Hospitals under Medical Alliance in Sanming

Objective:To analyze the current structure and influencing factors of the increase in medical expenses in public hospitals under the Medical Union in Sanming.Methods:The structure decomposition method(SDA)is used to analyze the medical expenses growth.Descriptive analysis and stepwise regression model are used to analyze the structural difference of the health resource supply structure to the growth of medical expenses.Results:The health resource supply structure shows a clustering situation centered on Meilie,Sanyuan and Yong’an,and the distribution of medical expenses matched the structure of resource allocation.The utilization of primary health services within the Medical Federation has increased significantly(54.51%),and the effectiveness of dual referrals has initially appeared.The cost breakdown structure shows that the inflation effect of medical expenses has always been the primary driving factor for the growth of hospitalization expenses(66.72%),while the scale effect of patient flow has increased significantly(30.83%).The structure of health resource supply affects the structure of cost growth.Per capita health technician has a significant positive impact on the inflation effect of medical expenses(β=0.661,P<0.000).Conclusion:The construction of medical consortium has shown a preliminary guiding effect on the growth structure of medical expenses in Sanming,realizing the flow of patients among different levels of medical institutions.The structure of health resource supply and the structure of cost growth are closely related.It is recommended to carry out in-depth reforms in terms of total supply and structure,increase the construction of the health resource service system in remote counties,promote the sinking of high-quality medical resources in the medical association,achieve complementary advantages and resource sharing,and guide the reasonable growth of medical expenses.