目的:分析我国医改政策对医疗卫生机构诊疗人次的影响,为实现分级诊疗提出政策建议。方法:以关键医改政策颁布时间为节点,构建医院、基层医疗卫生机构以及三级医院诊疗人次的分段回归模型。结果:医院和基层医疗卫生机构月增加的诊疗人次分别为145.795万人和68.652万人;2015年9月在全国推进分级诊疗政策后医院诊疗人次在相同变化率下平均水平降低1 542.461万人;2016年1月在全国层面推行城乡医保整合后医院诊疗人次在相同变化率下平均增加1 354.540万人,基层医疗卫生机构降低165.701万人。结论:我国当前分级诊疗的进展情况不容乐观,分级诊疗的实施未达到预期的政策效果,医保政策未能与分级诊疗的相关政策形成合力,提示应该加大政策执行力度,充分发挥政策合力,实现分级诊疗。
Objective: To analyze the impact of China's medical reform policy on the number of patients in medical and health institutions, and put forward policy suggestions for the realization of hierarchical diagnosis. Methods: A piece wise regression model of the number of patients in hospitals, primary medical institutions and tertiary hospitals was established by taking the time when key medical reform policies were issued as a node. Results: The number of visits by doctors and doctors in hospitals and primary-level medical and health institutions increased by 1.457 95 million and 0.686 552 million, respectively. In September 2015, the average number of hospital visits decreased by 15.424 61 at the same rate of change after the nationwide promotion of the tiered medical treatment policy. In January 2016, after the nationwide implementation of the integrated urban and rural medical insurance system, the number of visits by hospitals increased by an average of 13.545 4 million, and the number of visits by community-level medical and health institutions decreased by 1.657 01 million. Conclusion: The current progress of hierarchical diagnosis in China was not optimistic. The implementation of hierarchical diagnosis did not reached the expected policy effect, and the medical insurance policy did not formed synergy with the related policies of hierarchical diagnosis, suggesting that it should strengthen the policy implementation, give full play to the synergy of policy, and realize the hierarchical diagnosis.
Chinese Health Economics
medical and health policy, medical and health institution
stepwise regression analysis