总额预付制对公立医院基本医疗保险运行效果的影响——以北京大学肿瘤医院为例

目的：分析总额预付制实施前后公立医院运行变化，为制度的持续推进提供参考。方法：收集制度实施前后门诊和住院数据，对次均费用、药占比、自费比例等进行统计对比，运用秩和比法综合评价。结果：次均费用有效压缩，就诊人次有所增长，药占比有所降低，自费比例略有提高；综合评价发现，制度实施后基本医疗保险的运行效果得到综合改善。结论：总额预付制度改革达到初步预期，医保管理运行效果改善，自费比例的提升存在客观因素。建议：在推动总额预付工作时要深化工作考核方案，加强针对肿瘤患者的医保政策倾斜，提供有效的补充医疗保险方式，提升我国医疗保障能力。

The impact of global budget on operational effect of basic medical insurance.. A case study of Beijing Cancer Hospital

Objective: To analyze the changes in all related indexes before and after the implementation of the Global Budget (GB) program and to provide a reference for continuous improvement of medical insurance system. Methods: Using data obtained from hospital database, we compared changes in the average expenditures per time, the proportion of drug costs, and the percentage of self-payments. The analysis was conducted using the Rank Sum Ratio (RSR) method. Results: The results revealed that implementation of GB program resulted in a decrease in the average expenditures per time and the proportion of drug costs. The percentage of self-payments and patient visits increased over the same period of time. The RSR model indicated that all indexes improved remarkably after the GB was implemented. Conclusion: The GB program has reached its preliminary expectations. Excessive medical treatments are reducing and the increasing rate of medical cost is slowing down. We suggest that supplementary medical insurance for cancer patients may improve the overall quality of medical insurance.