中国上海市长宁区家庭医生与医疗保险支付协同改革的初步效果分析。
A preliminary effect analysis of family doctor and medical insurance payment coordination reform in Changning District of Shanghai, China.
机构信息
School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
School of Economics and Management, Hainan Normal University, Hainan, China.
出版信息
BMC Fam Pract. 2019 May 10;20(1):60. doi: 10.1186/s12875-019-0949-0.
BACKGROUND
Changning District of Shanghai pioneered in implementing Family Doctor and Medical Insurance Payment Coordination Reform. The survey aimed to assess the effect of the reform to provide a decision-making basis for ensuring the "gatekeeper" role of the family doctor.
METHODS
A cross-sectional survey was conducted using a self-designed questionnaire in Changning District of Shanghai during January and February in 2014. Multi-stage random cluster was applied and 3040 residents were selected. Comparisons were made with statistically test between the contracted and non-contracted residents in four policy targeted dimensions, doctor-visiting behavior, health management and status, medical cost control and satisfaction.
RESULTS
Compared with the non-contracted residents, the contracted residents (72.9%) presented a higher prevalence rate of chronic diseases (32.6%), a higher proportion (51.9%) in first-contact in the community health service center and a higher proportion to refer to specialists as well (P < 0.001).The result showed that the average annual medical expense were significantly higher than non-contracted residents (P < 0.001), however, the difference disappeared after age, medical insurance and other socio-demographic variables were controlled. In terms of self-management of non-communicable diseases and complication prevention, the blood pressure control rate and blood glucose control rate for the contracted group were also higher than the counterparts, reaching up to 85.6 and 72.7% respectively.
CONCLUSION
The preliminary analysis indicated that the contracted residents performed better in orderly doctor visiting behavior, health management behavior, health status and satisfaction. Follow up survey is necessary to further analyze the policy effect.
背景
上海市长宁区率先实施家庭医生制和医保支付协同改革。本调查旨在评估改革效果，为保障家庭医生的“守门人”角色提供决策依据。
方法
2014 年 1-2 月采用自行设计的问卷，在上海市长宁区进行横断面调查。采用多阶段随机整群抽样方法，抽取 3040 名居民。在四个政策目标维度（就诊行为、健康管理和状况、医疗费用控制和满意度）上，对签约和非签约居民进行统计学检验比较。
结果
与非签约居民相比，签约居民（72.9%）慢性病患病率较高（32.6%），社区卫生服务中心首诊比例较高（51.9%），转诊至专科医生的比例也较高（P < 0.001）。结果显示，签约居民的年医疗费用平均明显高于非签约居民（P < 0.001），但在控制年龄、医疗保险和其他社会人口统计学变量后，差异消失。在非传染性疾病的自我管理和并发症预防方面，签约组的血压控制率和血糖控制率也高于对照组，分别达到 85.6%和 72.7%。
结论
初步分析表明，签约居民在有序就诊行为、健康管理行为、健康状况和满意度方面表现较好。需要进行随访调查，以进一步分析政策效果。
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