【摘要】：目的:建立基于風險調(diào)整的門診統(tǒng)籌按人頭付費支付標準。方法:利用深圳市社會醫(yī)療保險信息系統(tǒng)2014—2015年的數(shù)據(jù),采用描述性統(tǒng)計對參保人員參保情況和就診情況進行描述,采用兩部模型進行風險調(diào)整模型建模估計。結(jié)果:參保人群月門診人均總費用預測值為6.17元,同時篩選出年齡、性別、醫(yī)保參保檔次、是否慢病或大病患者4個因素作為風險調(diào)整因素,據(jù)此確立了52個不同人群組別的人頭費用標準。結(jié)論:根據(jù)參保者的患病風險和預期衛(wèi)生服務利用對按人頭付費進行風險調(diào)整,建立相對可操作的人頭費用調(diào)整方法,為各地開展按人頭付費改革和后續(xù)進一步研究提供參考。
[Abstract]:Objective: to establish a head-to-head payment standard for outpatients based on risk adjustment. Methods: using the data of Shenzhen Social Medical Insurance Information system from 2014 to 2015, descriptive statistics were used to describe the insurance situation and medical treatment, and two models were used to model and estimate the risk adjustment model. Results: the average monthly total cost of outpatients was estimated to be 6.17 yuan, and age, sex, grade of insurance coverage, slow disease or serious illness were selected as risk adjustment factors, and the risk adjustment factors included age, sex, medical insurance coverage grade, slow disease or serious illness. Based on this, the head cost criteria for 52 different population groups were established. Conclusion: according to the risk of health service and the risk adjustment of head-to-head payment, a relatively operational method of head-cost adjustment is established, which can provide reference for the reform of head-to-head payment and the further study in the future.
【作者單位】： 華中科技大學同濟醫(yī)學院醫(yī)藥衛(wèi)生管理學院;南方醫(yī)科大學南方醫(yī)院;華中科技大學同濟醫(yī)學院附屬同濟醫(yī)院;
【基金】：國家自然科學基金項目(71273100) 華中科技大學“中央高�；究蒲袠I(yè)務費”(2016AB022)
【分類號】：F842.684;R197.1

【相似文獻】

相關期刊論文 前2條

1 孫宏鵬;劉美娜;;風險調(diào)整原理及在醫(yī)學中的應用[J];中國衛(wèi)生統(tǒng)計;2013年06期

2 鄭娟;王健;;風險調(diào)整及其在衛(wèi)生領域中的應用[J];中國衛(wèi)生經(jīng)濟;2014年04期

相關博士學位論文 前1條

1 王絢;基于透明監(jiān)管的手術(shù)部位感染指標遴選及風險調(diào)整研究[D];華中科技大學;2016年

，

本文編號：2458378