Analysis on the Influence of total Prepaid Health Insurance System on the Running of Specialized Hospital

本文以某口腔医院为研究对象，对总额预付实施前后的医疗服务量、医药总费用、次均费用、自费比等指标进行对比分析，并针对总额预付后医师诊疗行为的变化进行调查研究，以及探讨可能引发的潜在问题。结果表明总额预付对口腔医药总费用增长的管控作用有所显现，尤其对门急诊医药费用增长管控作用发挥显著，但住院费用管控效果并不明显。对医保服务量的增长速度控制有所显现，趋于合理持续增长态势。但对次均费用、自费比等指标的管控效果尚未显现，口腔服务的利用率提高，口腔服务的不公平性加剧，需要进一步完善支付方式配套措施以达到总额预付改革目的。Using the data of a dental hospital, to analyze the impact of total budget on the quality of medical services, total medical cost, average cost, and ratio of out-of-pocket expense, to study the changes of services behavior of the dentists, and to investigate potential issues caused by this policy. The results indicate that global budget (GB) has certain impact on controlling the growth of total medical expenditure, especially that of outpatient and emergency services, but not that of inpatient. It also has controlled the growth speed of the total service numbers, which trend to be reasonable. While, it did not have signiifcant impact on the average medical cost per time and the ratio of out-of-pocket expense, but has increased the utilization of dental services. However, it caused the problem of uneven access to services, so we should improve supportive payment methods to achieve the goal of total budget control.752-5