东中西部社区卫生服务站医保纳入及实施效果比较分析

目的：了解我国东、中、西部社区卫生服务站医保政策实施情况及其效果。方法：利用社区卫生服务全国重点联系城市常规监测数据,采用χ2检验、wilcoxon秩和检验和Kruskal-WallisH检验方法进行统计分析。结果：（1）2009年,东、中、西部地区社区卫生服务站医保定点比例分别为66.52%、56.35%、66.43%。（2）服务提供效率与利用率：东部地区医保定点站医生日均门诊服务数量高于非定点站,居民人均门诊服务利用数量低于非定点站;中部地区医保定点与非定点站医生日均门诊服务数量和居民人均门诊服务利用数量差异均无统计学意义;西部地区医保定点站医生日均门诊服务数量和居民人均门诊服务利用数量均高于非定点站。（3）门急诊服务量与业务收入：东、西部地区医保定点站平均门急诊服务量和业务收入均高于非定点站;中部地区医保定点与非定点站的平均门急诊服务量无统计学差异,医保定点站平均业务收入高于非定点站。有医保收入的站中,东、中、西部地区医保收入占业务收入的比例分别为44.80%、19.97%、37.57%。结论与建议：加大财政投入,提高社区卫生服务站医保定点比例;适度增加东部地区医保定点站人员数量,提高服务能力;促进社区卫生服务站与医保政策的有效衔接,充分发挥医保政策效果。

A comparative analysis on implementation and effect of medical insurance policy in community health service stations in the eastern, central and western regions

Objectives：To investigate the implementation status of health insurance and its effect in community health service stations in eastern,central and western China.Methods：Applying χ2 test,wilcoxon rank test and Kruskal-Wallis H test to describe and compare the implementation of health insurance and its effect in different regions.Results：（1） The proportions of community health service stations covered by health insurance in the eastern,central and western regions were 66.52%,56.35% and 66.43% respectively in 2009.（2） Efficiency of service delivery and utilization：in the eastern region,numbers of daily outpatient consultations per doctor of community health service stations covered by health insurance were significantly higher than those not covered.However,the quantity of service utilization per resident in community health service stations covered by health insurance was significantly lower than those not covered.In the central region,the number of daily outpatient consultations per doctor and quantity of service utilization per resident showed no significant difference between community health service stations covered by health insurance and those not covered,while in the western region,the daily capacity of outpatient service per doctor and quantity of service utilization per resident of these two indicators were both significantly higher in community health service stations covered by health insurance than those not covered.（3） number of of outpatient consultation and revenue：in the eastern and western regions,the average number of outpatient consultations and the average revenue of community health service stations covered by health insurance were significantly higher than those no covered;in the central region,the average number of outpatient consultations showed no significant difference between the two types of community health service stations.However,the average revenue of the community health service stations covered by health insurance was significant higher than those not covered.In the community health service stations with health insurance revenue,the proportions of revenue from health insurance in the eastern,central and western areas were 44.80%,19.97% and 37.57% respectively.Conclusions and Suggestions：Increase financial input to improve the proportion of community health service stations covered by health insurance;supplement medical staff quantity in community health stations in eastern region to improve their service;provision capacity;promote community health service stations to connect with medical insurance policy effectively for health insurance policy to fully achieve its effect.