Shanghai Pudong New Area People's Hospital, Shanghai 201299, China.
The First Affiliated Hospital of Hainan Medical University, Haikou 571199, China; and School of Management, Hainan Medical University, Haikou 571199, China; and School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
Aust J Prim Health. 2023 Aug;29(4):332-340. doi: 10.1071/PY22115.
To achieve proper health utilisation among various health institutions and improve primary care capacity, China implemented medical alliance (MA) reform as part of healthcare reforms in 2009. With chronic disease management as the focus and priority of primary health institutions, this study aimed to analyse the specific distribution and trends of outpatient visits to various levels of health institutions (community health centres (CHCs) vs hospitals) in MAs.
All outpatient data were extracted from the Chuansha MA in Pudong New Area, Shanghai, between 2016 and 2020, and submitted to descriptive analysis, Chi-Square tests and correlation analysis.
This article found that outpatients aged >60years visited CHCs more than hospitals for some chronic diseases. The adjusted average costs of outpatients presented upward trends both in hospitals and in CHCs.
The Chuansha MA worked in guiding older outpatients to visit CHCs, but did not control the increasing medical costs. The Shanghai government should further improve medical capability of CHCs to attract all community-dwelling residents at all ages to implement hierarchical diagnosis and treatment systems, as well as make more efforts to control increasing medical costs.
为了在各医疗机构之间实现合理的医疗资源利用，提高基层医疗服务能力，中国在 2009 年医改中实施了医疗联合体（MA）改革。由于慢性病管理是基层医疗机构的重点和优先事项，本研究旨在分析 MA 中各级医疗机构（社区卫生服务中心（CHC）与医院）的门诊就诊的具体分布和趋势。
本研究从上海市浦东新区川沙 MA 2016 年至 2020 年期间提取了所有的门诊数据，并进行了描述性分析、卡方检验和相关性分析。
本研究发现，某些慢性病患者中，年龄 >60 岁的门诊患者更倾向于前往 CHC 就诊，而不是医院。医院和 CHC 门诊患者的调整后平均费用均呈现上升趋势。
川沙 MA 在引导老年门诊患者前往 CHC 就诊方面发挥了作用，但并未控制医疗费用的增长。上海市政府应进一步提高 CHC 的医疗能力，吸引各年龄段的所有社区居民实施分级诊疗制度，并努力控制医疗费用的增长。
