Wu Zhi-jun, Jian Wei-yan
Department of Health Policy and Administration, Peking University School of Public Health, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2015 Jun 18;47(3):469-73.
To study the influence of contractual medical association on inpatient service performance.
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.
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 declined, and the cost efficiency index had increased.
Contractual medical association played a role of triage patients, and improved the service levels and management efficiency of the second-tier general hospitals.
研究医联体对住院服务绩效的影响。
数据来源于医保部门管理的“住院病案数据库”。以诊断相关分组(DRG)作为风险调整工具,将医联体内的三级综合医院和二级综合医院作为干预组,将当地同等级医院的平均水平作为对照组,评估医联体对住院服务绩效的影响。数据分析采用双重差分法(DID)。评估指标包括DRG组数、病例组合指数(CMI)、总权重、成本效率指数和时间效率指数。
医联体建立后,与当地同等级医院平均水平相比,医联体中的三级综合医院总权重增长率下降,成本效率指数上升;而医联体中的二级综合医院CMI值下降,成本效率指数上升。
医联体起到了患者分流的作用,提高了二级综合医院的服务水平和管理效率。