广西紧密型县域医疗卫生共同体建设中分级诊疗实施效果的影响路径分析
Analysis of the Impact Pathways for Hierarchical Medical Care Implementation in Integrated County-level Medical and Health Communities in Guangxi
黄凌波 1彭蓉 1康静 1刘佩芸 1冯启明 1覃娴静1
作者信息
- 1. 广西医科大学卫生与健康政策研究中心 (广西高端智库建设培育单位),广西南宁,530021;广西医科大学信息与管理学院,广西南宁,530021
- 折叠
摘要
目的:分析广西紧密型县域医疗卫生共同体(以下简称"医共体")建设中分级诊疗实施效果的影响路径,为医共体建设提供参考.方法:以2019-2021 年 39 个广西紧密型县域医共体试点为研究样本,运用模糊集定性比较分析法(fsQCA)与必要条件分析法(NCA),分析医共体建设中分级诊疗实施效果的影响机制与提升路径.结果:多种因素联动影响医共体建设中分级诊疗实施效果,其中有2 类主导作用,分别是医保基金使用效能的主导作用、医疗收入结构优化的主导作用,组态分析结果解释力较强(一致性>0.8、覆盖度>0.5).结论:医共体内分级诊疗实施效果的提升是综合多方面因素作用的结果,应以整体县域为关注点,合理降低住院次均费用,加快医保支付方式改革,提升医保基金使用效能,完善基层医疗卫生机构价格补偿机制,逐步优化医疗收入结构.
Abstract
Objective:Analyze the impact pathways for the implementation of hierarchical medical care within the integrated county-level medical and health communities in Guangxi,providing references for the construction of these communities.Methods:Utilizing 39 pilot integrated county-level medical and health communities in Guangxi from 2019 to 2021 as the research sample,this study employs fuzzy-set qualitative comparative analysis(fsQCA)and necessary condition analysis(NCA)to explore the de-terminants and strategies for enhancing the implementation of hierarchical medical care.Results:Multiple interacting factors influ-ence the effectiveness of hierarchical medical care implementation.Two dominant factors are identified:the effectiveness of medical insurance fund utilization and the optimization of medical income structures.These factors are strongly supported by the configura-tional analysis(consistency>0.8,coverage>0.5).Conclusion:Enhancing the implementation effects of hierarchical medical care in these communities results from a comprehensive interaction of various factors.Recommendations include focusing on the en-tire county,reducing the average cost of hospitalizations,accelerating medical insurance payment reform,enhancing the use of medical insurance funds,improving the pricing compensation mechanism for primary healthcare institutions,and gradually optimi-zing medical income structures.
关键词
紧密型县域医疗卫生共同体/分级诊疗/实施效果/广西Key words
Integrated County-level Medical and Health Community/Hierarchical Medical Care/Implementation Effect/Guangxi引用本文复制引用
基金项目
广西自然科学基金青年科学基金资助项目(2020JJB180002)
广西特色新型智库联盟重点课题()
2023年度广西特色新型智库联盟重大专题研究项目(GXZC2023-C3-001424-GTZX)
广西卫生健康委委托项目()
出版年
2024
NETL
NSTL
万方数据