陕西省分级诊疗制度实施效果评价(1)
摘要：目的 本研究通過对陕西省分级诊疗实践现状的分析，总结陕西省分级诊疗改革存在的问题，针对问题提出改进陕西省分级诊疗模式的措施，为陕西省分级诊疗的进一步完善提供理论依据，为国家政策的制定提供决策参考。方法 采用自行设计调查问卷的方式，从分级诊疗制度的基本运行情况、疾病分组情况、医保补偿情况等多个方面对陕西省分级诊疗制度的实施状况进行分析。结果 样本人群中不同年龄组患者的性别分布有明显的差异，其中患者人数最多的3个年龄组是：60～69岁年龄组656人(18.63%)、0～9岁年龄组602人(17.10%)和50～59岁年龄组593人(16.85%)。女性高于男性，提示陕西省女性患者对于分级诊疗制度的依从性高于男性(P<0.05);陕西省分级诊疗制度覆盖了ICD-10的16类疾病，患者人数排在前3位的疾病是：循环系统疾病1016人(28.86%)、呼吸系统疾病725人(20.60%)和消化系统疾病643人(18.27%);分级诊疗制度和其他惠民政策的覆盖频数的差异无统计学意义(P>0.05)。结论 惠民政策在影响老百姓就医过程中是否发生自费行为的作用有限;年龄因素可能是影响分级诊疗制度实际报销比例的因素之一;疾病的分类可能是影响分级诊疗制度实际报销比的因素之一。陕西省分级诊疗制度取得一定的成就，但是与其他政策的联动作用没有体现出来，医保政策在保障分级诊疗制度的落地起到了十分关键的作用，同时在减轻群众的就医负担上起到了不可替代的作用。
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关键词：分级诊疗;医疗改革;诊疗模式;医保补偿
中图分类号：R197.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.06.001
文章编号：1006-1959(2019)06-0001-04
Abstract：Objective This study summarizes the problems existing in the grading diagnosis and treatment reform in Shaanxi Province through the analysis of the status quo of the grading diagnosis and treatment practice in Shaanxi Province， and proposes measures to improve the grading diagnosis and treatment model in Shaanxi Province， and provides a theoretical basis for the further improvement of grading diagnosis and treatment in Shaanxi Province. Policy development provides a reference for decision making. Methods The self-designed questionnaire was used to analyze the implementation status of the graded diagnosis and treatment system in Shaanxi Province from the basic operation of the graded diagnosis and treatment system， the disease grouping and the medical insurance compensation. Results There were significant differences in gender distribution among the different age groups in the sample population. The three age groups with the highest number of patients were： 656 people (18.63%) in the 60-69 age group and 602 people in the 0-9 age group (17.10%) and 593 people (16.85%) in the 50-59 age group. Women were higher than males， suggesting that female patients in Shaanxi Province were more compliant with men than the males (P<0.05).The grading diagnosis and treatment system of Shaanxi Province covers 16 types of diseases of ICD-10. The top 3 diseases are： 1016 (28.86%) circulatory diseases， there were 725 respiratory diseases (20.60%) and 643 digestive diseases (18.27%). There was no significant difference in the coverage frequency between the graded diagnosis and treatment system and other benefits policy (P>0.05). Conclusion The policy of benefiting people has a limited effect on whether self-expense behavior occurs in the process of seeking medical treatment， and age may be one of the factors that affect the actual reimbursement ratio of grading diagnosis and treatment system. The classification of diseases may be one of the factors that affect the actual reimbursement ratio of grading diagnosis and treatment system. Shaanxi's hierarchical diagnosis and treatment system has made certain achievements， but the linkage with other policies has not been reflected， and the medical insurance policy has played a very key role in ensuring the landing of the hierarchical diagnosis and treatment system. At the same time， it plays an irreplaceable role in lightening the burden of medical treatment of the masses., 百拇医药(张真妮 李浩)
, http://www.100md.com
关键词：分级诊疗;医疗改革;诊疗模式;医保补偿
中图分类号：R197.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.06.001
文章编号：1006-1959(2019)06-0001-04
Abstract：Objective This study summarizes the problems existing in the grading diagnosis and treatment reform in Shaanxi Province through the analysis of the status quo of the grading diagnosis and treatment practice in Shaanxi Province， and proposes measures to improve the grading diagnosis and treatment model in Shaanxi Province， and provides a theoretical basis for the further improvement of grading diagnosis and treatment in Shaanxi Province. Policy development provides a reference for decision making. Methods The self-designed questionnaire was used to analyze the implementation status of the graded diagnosis and treatment system in Shaanxi Province from the basic operation of the graded diagnosis and treatment system， the disease grouping and the medical insurance compensation. Results There were significant differences in gender distribution among the different age groups in the sample population. The three age groups with the highest number of patients were： 656 people (18.63%) in the 60-69 age group and 602 people in the 0-9 age group (17.10%) and 593 people (16.85%) in the 50-59 age group. Women were higher than males， suggesting that female patients in Shaanxi Province were more compliant with men than the males (P<0.05).The grading diagnosis and treatment system of Shaanxi Province covers 16 types of diseases of ICD-10. The top 3 diseases are： 1016 (28.86%) circulatory diseases， there were 725 respiratory diseases (20.60%) and 643 digestive diseases (18.27%). There was no significant difference in the coverage frequency between the graded diagnosis and treatment system and other benefits policy (P>0.05). Conclusion The policy of benefiting people has a limited effect on whether self-expense behavior occurs in the process of seeking medical treatment， and age may be one of the factors that affect the actual reimbursement ratio of grading diagnosis and treatment system. The classification of diseases may be one of the factors that affect the actual reimbursement ratio of grading diagnosis and treatment system. Shaanxi's hierarchical diagnosis and treatment system has made certain achievements， but the linkage with other policies has not been reflected， and the medical insurance policy has played a very key role in ensuring the landing of the hierarchical diagnosis and treatment system. At the same time， it plays an irreplaceable role in lightening the burden of medical treatment of the masses., 百拇医药(张真妮 李浩)