契约式医疗联合体对医院住院服务绩效影响的初步分析

目的：研究契约式医疗联合体对医院住院服务绩效的影响。方法：从当地医保部门主管的出院患者病案基本信息数据库中，采集该地2011年至2013年医保出院病例病案首页，利用诊断相关组（diagnosis related groups，DRG）对疾病进行风险调整，以医疗联合体内三级医院和二级医院作为干预组，当地同级别医院的平均水平作为对照组，利用双重差分的基本思想从DRG组数、病例组合指数（case mix index，CMI）、总权重数、费用效率指数和时间效率指数5个方面评价医疗联合体对医院住院服务绩效的影响。结果：实行医疗联合体后，相比当地各类医院的平均水平，医疗联合体内三级医院的总权重数增速有所下降，费用效率指数有所上升，二级医院的CMI值有所下降，费用效率指数有所上升。结论：契约式医疗联合体起到一定的患者分流作用，可以有效提高二级医院的服务水平和管理效率。

Influence of contractual medical association on inpatient service performance

Objective: To study the influence of contractual medical association on inpatient service performance. Methods:The data came from“Database of Inpatient Record” administered by Department of Medical Insurance. Using diagnosis related groups ( DRG) as the tool of risk-adjustment, the third-tier general hospitals and second-tier general hospitals in medical alliance as the intervention group, and the average level of the same grade local hospitals as the control group, the influence of medical alliance on inpatient service performance was evaluated. The difference in difference ( DID) method was used for the data analysis. The assessing indicators included the number of DRG group, case mix index ( CMI) , the total weight, cost efficiency index and time efficiency index. Results:After the establishment of medical association, compared with the average level of the same grade local hospitals, in the third-tier general hospitals of medical alliance, the growth rate of the total weight had declined, and cost efficiency index had increased, while in the second-tier general hospitals of medical alliance, the CMI value had de-clined, and the cost efficiency index had increased. Conclusion:Contractual medical association played a role of triage patients, and improved the service levels and management efficiency of the second-tier general hospitals.