基于卫生费用视角的北京市基层医疗卫生资金的筹集与消耗状况研究
Research on the Financing and Components of Recurrent Health Expenses in Primary Healthcare Institutions in Beijing-Based on SHA2011
背景 基层医疗卫生机构是分级诊疗的关键环节，国家政策强调要深化“强基层”改革，发挥其“网底”作用。目的 了解北京市基层医疗卫生服务发展与资源利用情况，为下一步优化基层医疗卫生机构资源配置提供政策建议。方法 以 SHA2011 为基础，采用分层和简单随机抽样相结合的方法，共抽取医疗卫生机构 29 家。依据国际疾病分类 ICD-10 编码形成数据库，完成北京市经常性卫生费用核算。卫生费用总量数据来源于中国卫生健康统计年鉴、北京卫生健康统计年鉴、北京市政府卫生投入监测系统、北京市公共卫生信息中心等。核算 2014—2020 年基层医疗卫生机构卫生费用概况、筹资来源和功能流向（包括治疗服务费用和预防服务费用）。结果 基层卫生费用由 122.31亿元增至 327.61 亿元，年均增速为 15.53%，其占卫生费用的比重由 7.93% 增长至 13.61%，基层卫生费用筹资方案以社会基本医疗保险方案、政府方案为主，家庭卫生支出占比由 18.65% 降至 8.30%；治疗服务费用占比由 87.49% 波动下降至 77.73%，主要由内分泌、中医、循环系统疾病这三类患者消耗，累计占比在 60.00% 以上，基层治疗服务的主要人群是 60 岁以上的老年患者，其费用占比由 48.92% 增至 64.31%；预防服务费用的占比由 12.51% 波动增长至22.27%，基层预防服务资源主要由中医药健康管理、免疫规划、健康教育、老年人健康管理、慢性病管理等预防服务项目消耗。结论 分级诊疗成效初显，基层医疗资源发展迅速，在首都医疗卫生体系中发挥重要作用。政府承担基层重要筹资责任，居民个人负担下降，基层患者以老年、慢性非传染性疾病患者为主，预防服务能力不断提升，应针对需求，精准配置基层医疗卫生资源，关注重点公卫任务，把握服务新特点。
Background Primary healthcare institutions are the key link in hierarchical diagnosis and treatmentand national policies emphasize the need to deepen the "strong grassroots" reform and play its role as the "bottom of the net". Objective To understand the development and resource utilization of primary healthcare services in Beijingand provide policy suggestions for optimizing the resource allocation of primary healthcare institutions in the next step. Methods Based on SHA2011a combined method of stratified and simple random sampling was used to select a total of 29 medical and health institutions. A database was formed based on the International Classification of Diseases ICD-10 coding to complete the accounting of recurrent health expenses in Beijing. The data concerning Beijing health expenses were derived from China Health Statistics YearbookBeijing Health Statistics YearbookBeijing Municipal Government Healthcare Subsidies Monitoring SystemBeijing Public Health Information Centerand so on. The overviewfunding sourcesand functional flow of health expenses including treatment service expenses and prevention service expenses in primary healthcare institutions from 2014 to 2020 were analyzed. Results The recurrent health expenses for Beijing's primary healthcare institutions increased from 12.231 billion yuan to 32.761 billion yuanwith an average annual growth rate of 15.53%and its proportion in health expenses increased from 7.93% to 13.61%.The inputs were mainly from medical insurance reimbursement programs and Beijing municipal government subsidieswhile the proportion of household health expenses has decreased from 18.65% to 8.30%.The proportion of treatment service expenses fluctuated from 87.49% to 77.73%mainly consumed by endocrinetraditional Chinese medicine and circulatory system diseasesaccounting for more than 60.00% cumulatively. The main population of primary treatment services was elderly patients over 60 years oldand the proportion of expenses increased from 48.92% to 64.31%.The proportion of preventive service expenses fluctuated from 12.51% to 22.27%and the resources of grassroots preventive services were mainly consumed by preventive services such as traditional Chinese medicine health managementimmunization planninghealth educationelderly health managementand chronic disease management. Conclusion The results of hierarchical diagnosis and treatment are initially obviousand the primary healthcare resources develop rapidlywhich plays an important role in the medical and health system of the capital. The government has assumed important funding responsibilities at the grassroots level the personal burden of residents has declinedthe grassroots patients are mainly elderly and chronic non-communicable disease patientsand the prevention service capacity has been continuously improved.
肖珊珊、满晓玮、蒋艳
医药卫生理论预防医学中医学
卫生服务研究分级诊疗基层医疗卫生机构经常性卫生费用SHA2011
肖珊珊,满晓玮,蒋艳.基于卫生费用视角的北京市基层医疗卫生资金的筹集与消耗状况研究[EB/OL].(2024-04-24)[2025-08-30].https://chinaxiv.org/abs/202404.00337.点此复制
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