摘要
目的比较不同模式整合型医疗卫生服务体系转诊患者次均交易费用差异。方法采用典型抽样法,选取青海省D市县域医共体、河南省郑州市J区城市医疗集团和山东省N县健康管理联合体的转诊患者为研究对象,调查患者基本信息、次均交易费用及认知评价。采用t检验和单因素方差分析检验次均交易费用在变量间的差异,通过广义线性回归模型分析不同模式的影响因素。结果915名患者中,县域医共体、城市医疗集团和健康管理联合体次均交易费用分别为1035.05元、195.31元和700.97元,经单因素方差分析检验,差异有统计学意义(P<0.05)。城市医疗集团时间成本与专项投入成本均低于其他模式;高龄(县域医共体),教育水平、就业状况和转诊交通时间(城市医疗集团)和居住地(健康管理联合体)为关键影响因素;患者费用认知在模式间差异有统计学意义(P<0.05)。结论城市医疗集团的患者次均交易费用低于县域医共体与健康管理联合体,具备“患者交易费用最低”的制度优势。
Objective To compare the differences in the average transaction costs per-referral patients under different models of Integrated Delivery Systems(IDS).Methods Using a typical case sampling method,it selected referred patients from three IDS models:the county medical alliance in D City(Qinghai Province),the urban medical consortium in J District(Zhengzhou City,Henan Province),and the health management coalition in N County(Shandong Province).Structured questionnaires collected demographics,average transaction costs per-referral and cost perceptions.t-tests and ANOVA assessed cost differences;generalized linear regression identified influencing factors.Results Among 915 patients,the average transaction costs per-referral were 1035.05 yuan(county alliance),195.31 yuan(urban consortium),and 700.97 yuan(health management coalition),with statistically significant differences(P<0.05).The urban consortium exhibited lower time costs and specialized input costs.Key influencing factors included older age(county alliance),education level,employment status,and referral travel time(urban consortium),as well as urban-rural disparities(health management coalition).Patients’cost perceptions significantly differed across models(P<0.05).Conclusion The urban medical consortium demonstrated the lowest patient the average transaction costs,highlighting its institutional advantage in minimizing financial burdens.
作者
胡春平
崔金鑫
朱东方
赵秋平
王鹏飞
吴建
牛亚冬
苗豫东
Hu Chunping;Cui Jinxin;Zhu Dongfang;Miao Yudong(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,430030,China;不详)
出处
《中国医院管理》
北大核心
2025年第9期46-50,56,共6页
Chinese Hospital Management
基金
国家社会科学基金一般项目(21BGL222)
国家科技重大专项(2024ZD0526801)。
关键词
整合型医疗卫生服务体系
转诊患者
次均交易费用
Integrated Delivery System
referred patients
average transaction costs per-referral
