县域医共体改革对区乡医疗机构卫生服务效率的影响评价

目的评估县域医共体改革对区乡两级医疗机构卫生服务效率的影响。方法采用间断时间序列模型分析云南省临沧市L区医共体改革对区乡两级公立医疗机构卫生服务质量的影响。结果区级医疗机构出院患者数量和次均门诊费用改革后相较于改革前的变化趋势有差异(β3=-48.973,P=0.003;β3=-11.038,P=0.001),平均每月分别减少25.996人次和5.576元。乡镇卫生院患者平均住院日和人均住院费用改革后相较于改革前的变化趋势有差异(β1=-0.064,P<0.01;β3=32.747,P=0.016),平均每月分别增加0.095天和31.191元。结论县域医共体改革后,区级医疗机构出院患者数量由改革前的稳定变为改革后的明显减少,次均门诊费用由改革前的增加变为改革后的减少;乡镇卫生院患者平均住院日由改革前的减少变为改革后的增加,人均住院费用由改革前的稳定变为改革后的增加。

Impact of County Medical Alliance Reform on Health Service Efficiency of Medical Institutions at All Levels

Objective To evaluate the impact of county medical alliance reform on the efficiency of health services inmedical institutions at all levels.Methods A discontinuous time series was used to analyze the specific impact of the reform of the medical alliance in L District,Lincang City,Yunnan Province on the quality of health services at the district and township levels.Results The number of discharges and average outpatient costs of district-level medical institutions after the reform showed significant differences compared with those before the reform(β3=-48.973,P=0.003;β3=-11.038,P=0.001),with an average monthly decrease of 25.996 persons and a decrease of 5.576 yuan.The average length of hospitalization of discharged patients in township health centers and the average number of hospitalizations per patient were significantly different after the reform compared with before the reform(β1=-0.064,P<0.01;β3=32.747,P=0.016),with an average monthly increase of 0.095 days and 31.191 yuan,respectively.Conclusion After the reform of the county medical alliance,the number of discharged patients from district-level medical institutions has been significantly reduced,and the average outpatient cost per patient has changed from increase to decrease;the average hospital stay of discharged patients from township health centers has changed from decrease to increase,and the per capita hospitalization cost of patients has increased.