健康发展与政策研究2024，Vol.27Issue(6)：511-516,523,7.DOI:10.12458/HDPR.202409019
基于患者视角的整合型医疗卫生服务体系"转诊机制"交易费用
Transaction costs of the"referral mechanism"in integrated delivery systems:a patient perspective
摘要
Abstract
Objective To examine patients'awareness of the transaction costs of the"referral mechanism"in integrated medical and health service system,measure and compare the differences in transaction costs between urban and rural patients,and provide evidence to support the sustainable development of the mechanism.Methods A typical sampling method was used to select the hospitalized patients with hypertension and diabetes who turned up or down in the compact county-level medical community in D City of Haixi Prefecture,Qinghai Province,the urban medical group in J District of Zhengzhou City,Henan Province,and the health management union in N county of Dezhou City,Shandong Province,and patients'awareness of transaction costs was investigated.Based on the Williamson-Steven Cheung analysis paradigm,a method for transaction cost calculation was established to measure the average transaction cost per referral,and the transaction costs of urban and rural patients were compared by propensity score matching.Results A total of 915 referred patients were investigated,and the average transaction cost per referral was 647.68 CNY,including 348.61 CNY for the time cost and 299.07 CNY for special input cost.Over 29.29%of the referred patients considered that the cost of each part of the referral to be low or very low,while nearly 50%of the patients regarded them as moderate.The transaction costs were higher for male,younger,rural,highly educated,employed patients,those with longer referral transportation time,and those transferred both up and down.These differences were statistically significant(P＜0.05).Before and after propensity score matching,the transaction costs of urban patients(600.24 CNY and 547.87 CNY)were lower than those of rural patients(671.51 CNY and 934.74 CNY),with the differences being statistically significant(P＜0.001).Conclusions Patients have limited awareness of referral transaction costs,and the cost they incur in the process of referral is high,particularly for rural patients,whose costs are much higher than those of urban residents.To address transaction costs effectively,it is recommended that the healthcare providers streamline referral channels;the demand side should recognize the characteristics of transaction costs and seek medical treatment in an orderly manner;and the healthcare insurers should establish compensation and incentive measures.关键词
整合型医疗卫生服务体系/转诊机制/交易费用/患者Key words
integrated delivery systems/referral mechanism/transaction costs/patients分类
医药卫生引用本文复制引用
李淼军,朱东方,牛亚冬,王伟,苗豫东..基于患者视角的整合型医疗卫生服务体系"转诊机制"交易费用[J].健康发展与政策研究,2024,27(6):511-516,523,7.基金项目
国家社会科学基金一般项目(21BGL222) （21BGL222）
