Wang Yanmei, Shu Zhiqun, Gu Jianjun, Sun Xiaoming, Jing Limei, Bai Jie, Huang Xuan, Lou Jiquan, Zhang Qunfang, Li Ming
School of Nursing, Fudan University, Shanghai, China.
Shanghai Pudong Institute for Health Development, Shanghai, China.
Int J Health Plann Manage. 2017 Jul;32(3):307-316. doi: 10.1002/hpm.2432. Epub 2017 Jul 14.
Currently, China has been experiencing rapid growth of medical costs, serious waste of medical resources, increasing disease burden for residents, and a medical insurance fund deficit. Therefore, an urgent problem that needs to be solved is to choose a rational payment for the insurance system. To empirically evaluate the long-term effects of capitation reform in a New Rural Cooperative Medical Scheme in Pudong New Area, we collected and analysed data regarding financing, fund operation, medical service cost, and medical care-seeking behaviour from 2011 to 2015, a duration that includes data before and after reform. The data for financing and behaviours were compared year by year, and the monthly data for inpatient and outpatient costs were evaluated in a retrospective time series study. The capitation reform in Pudong New Area showed strong evidence of the power of medical cost control in the long run, while it was weak in reversing the number of patients flowing into secondary and tertiary hospitals. To make the payment of capitation play a bigger role in cost control in China, a tighter alignment of capitation with the general practitioner system and achieving dual referral is critical for future studies.
目前，中国正面临医疗费用快速增长、医疗资源严重浪费、居民疾病负担加重以及医疗保险基金出现赤字等问题。因此，亟待解决的一个问题是为保险制度选择一种合理的支付方式。为了实证评估浦东新区新型农村合作医疗按人头付费改革的长期效果，我们收集并分析了2011年至2015年期间关于筹资、基金运作、医疗服务成本和就医行为的数据，这一时间段涵盖了改革前后的数据。对筹资和行为数据逐年进行比较，并在一项回顾性时间序列研究中评估住院和门诊费用的月度数据。浦东新区的按人头付费改革有力地证明了从长远来看其在控制医疗费用方面的作用，而在扭转流入二级和三级医院的患者数量方面作用较弱。为了使按人头付费在我国成本控制中发挥更大作用，未来的研究中，使按人头付费与全科医生制度更紧密结合并实现双向转诊至关重要。
