北京市医药分开综合改革对门急诊患者就医流向的影响研究

目的:评价北京市医药分开综合改革的实施对于门急诊患者就医流向的影响。方法:对北京市卫计委信息中心收集的2016年1月—2017年10月的各级医疗机构门急诊就诊人次数据的变化趋势进行分析,并采用间断时间序列分析(Interrupted Time Series,ITS)方法分析北京市医药分开综合改革对其影响。结果:2017年4—10月,三级医院平均每家医疗机构门急诊人次同比下降12.11%;二级医院平均每家医疗机构门急诊人次同比下降2.10%;基层医疗卫生机构平均每家机构门急诊人次同比上升11.49%。结论:北京市医药分开综合改革通过医事服务费的调整和基层用药目录与三级医院对接等主要措施,使得门急诊患者就诊流向发生明显变化,长期下去需要引起注意的是基层是否有动力接收病人,以及能否接住病人的问题。

The comprehensive reform of separating drug sales from medical services and its impact on outpatients and emmergency medical flow in Beijing

Objectives:To evaluate the impact of the implementation of the comprehensive reform of separating drug sales from medical services on outpatient and emergency medical flow, and to analyze the reasons for the changes in the patient flow. Methods:The change and trend of outpatient and emergency services in medical institutions at all levels were analyzed using the monitoring data and historical data collected by Beijing Municipal Health and Family Planning Commission Information Center from January 2016 to October 2017. At the same time, the Interrupted Time Series (ITS) analysis was used to analyze the trends and changes in outpatient-emergency service indicators influenced by the Beijing''s comprehensive reform of separating drug sales from medical services. Results:After the implementation of the reform, the number of outpatient and emergency services in medical institutions generally showed a downward trend as compared with the same period of previous year. From April to October 2017, the number of outpatient and emergency services per medical institution in tertiary hospitals decreased by 12.11% as compared with the same period of previous year, and the trend of the rise in emergency services before the reform of tertiary hospitals reversed. The average number of outpatient and emergency services in secondary hospitals dropped by 2.10% compared with the same period in the previous year, while in primary medical institutions the number increased by 11.49% for the same considerations of yearly percentages and the upward trend of outpatient and emergency services in these primary medical institutions was even stronger after the reform. Conclusions:The comprehensive reform of separating drug sales from medical services in Beijing has made obvious changes in the flow of outpatient visits through the adjustment of medical service fees and the docking of public drug utilization catalogs with tertiary hospitals, and other strong measures as well as intended to make more successful the reform. In the long run, making outpatient emergency treatment flow has undergone significant changes, attention need to be paid to whether the the primary health institutions are willing to accept or how they can catch the patients.