目的 探讨甘肃省新农合分级诊疗的实施现状,为促进新农合分级诊疗制度的进一步完善提供政策建议.方法 于2016年3月,通过2014-2015年国家卫生计生统计信息网络直报数据,收集各级医疗机构的卫生资源配置、医疗服务利用、医疗服务效率、医疗服务费用、基层医疗卫生机构转诊情况指标;通过2014-2015年甘肃省新型农村合作医疗管理中心数据,收集甘肃省新农合筹资补偿、资金流向指标.结果 2015年甘肃省医疗机构总门诊人次较2014年增长7.56％,三级医院、县级医院、社区卫生服务中心(站)、村卫生室分别增长7.18％、8.82％、1.64％、0.03％,乡镇卫生院下降0.90％;总出院人次较2014年增长16.29％,三级医院、县级医院、乡镇卫生院、社区卫生服务中心(站)分别增长2.28％、33.05％、4.19％、17.02％.2015年甘肃省平均病床使用率较2014年下降0.59个百分点,三级医院、县级医院、社区卫生服务中心(站)分别下降1.92、1.55、0.64个百分点,乡镇卫生院增长1.08个百分点.2015年甘肃省门诊次均医疗费用较2014年增长9.19％,次均住院费用较2014年增长5.91％.2015年乡镇卫生院接诊下转人次较2014年下降0.60％,向上转诊人次较2014年增长17.95％.2015年甘肃省新农合统筹资金、基金支出、补偿人次分别较2014年增长21.69％、10.71％、17.74％,其中住院补偿人次和补偿基金分别较2014年增长10.38％、6.83％,县级医疗机构新农合住院补偿基金较2014年增长14.44％.结论 甘肃省新农合分级诊疗工作取得了一定成效,三级医院和基层医疗卫生机构的医疗服务量均有所提高,乡镇卫生院县域内首诊与双向转诊地位凸显,新农合基金县级医疗机构占比有所增长,但依然存在医疗资源浪费、基层医疗卫生机构服务水平不足、医疗信息共享不畅通等问题.%Objective To explore the implementation status about hierarchical medical system of new rural cooperative medical system in Gansu Province,so as to put forward policy recommendations for the improvement of this system.Methods In March 2016,information about health resources allocation,medical service utilization,medical service efficiency,medical service fee in medical institutions at all levels and primary medical institutions' transfer treatment during 2014 to 2015 were collected from the National Healthcare and Family Planning Statistical Information Direct Reporting Network,and the data about the expense and beneficiaries of new rural cooperative medical funding in Gansu Province from 2014 to 2015 were obtained from the Gansu New Rural Cooperative Medical System Management Center.Results Compared with 2014,in Gansu Province in 2015,the outpatient visits in all the medical institutions,tertiary hospitals,county-level hospitals,community health service centers (stations) and village clinics increased by 7.56％,7.18％,8.82％,1.64％,and 0.03％,respectively,but they decreased by 0.90％ for township health centers;the number of discharges in all the medical institutions,tertiary hospitals,county-level hospitals,township health centers and community health service centers (stations) increased by 16.29％,2.28％,33.05％,4.19％ and 17.02％,respectively;the average bed occupancy rate in all the medical institutions,tertiary hospitals,county-level hospitals and community health service centers (stations) dropped 0.59 percentage point,1.92,1.55 and 0.64 percentage point,respectively,but in township health centers,it increased 1.08 percentage point.The average cost for each outpatient visit and the average cost for each hospitalization in Gansu Province in 2015 increased by 9.19％ and 5.91％ respectively compared with 2014.In township health centers in Gansu Province in 2015,the number of downward referrals fallen by 0.60％,but the number of upward referrals increased by 17.95％ compared with 2014.The new rural cooperative medical system pooling funds,expenditure and reimbursement times increased by 21.69％,10.71％ and 17.74％,respectively in Gansu Province in 2015 compared with 2014,specifically,the average times and amount of reimbursement for each hospitalization increased by 10.38％ and 6.83％,respectively;the amount of reimbursement for county-level hospitals increased by 14.44％.Condusion The implementation of hierarchical medical system of new rural cooperative medical system in Gansu Province has made some achievements,such as the medical service workload has been increased in tertiary hospitals and primary medical institutions,first visits and dual referrals have increased significantly in intra-county township health centers,the percentage of reimbursement from the new rural cooperative medical fund enjoyed by the patients from county-level hospitals has increased,but there are still existing problems about wasting medical resources,lacking of qualified primary medical services and inefficient sharing of medical information and so on.
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