Study On Recurrent Health Expenses In Primary Healthcare Institutions In Anhui Province

Objective: Through accounting the recurrent health expenditure of primary medical and health institutions in Anhui Province in 2018,this paper deeply understands and analyzes the movement process of recurrent health funds of primary medical and health institutions in Anhui Province(the raising,distribution and use of primary health service funds),at the same time,understands the utilization and disease burden of primary medical and health services and prevention services,and discusses the beneficiaries The key points of disease prevention and control of the group are to provide support for the exertion and improvement of grassroots functions.Methods: By using the methods of literature review,field investigation and comparative study,and referring to the theory and framework of health expenditure accounting system 2011,this study tried to build the corresponding health expenditure accounting system and accounting framework of primary medical and health institutions in Anhui Province;then combined with methodology,the field investigation of medical institutions in Anhui Province was conducted to obtain various data.Then use excel2018,stata2.0 and spss22.0 software to sort out and analyze the relevant data.Based on the total data of primary medical institutions in Anhui Province,using the method and principle of total allocation,the primary medical economic health expenses in Anhui Province are divided into therapeutic and preventive recurrent health expenses,which are separately allocated and accounted from the source of financing,function flow and population At the same time,a comparative study of the cost and flow between horizontal institutions is carried out.Results:(1)The total cost of treatment and prevention services of primary medical and health institutions in Anhui Province: in 2018,the recurrent health expenditure of primary medical and health institutions accounted for 17.17% of the total scale of Anhui Province.Among them,the cost of treatment was 22.537 billion yuan,accounting for 15.96% of that of the whole province,and the cost of prevention was3.219 billion yuan,accounting for 36.54% of that of the whole province.(2)Treatment expenses of primary medical and health institutions in Anhui Province in 2018: from the perspective of financing,the main source of financing is individual direct payment,accounting for nearly 60%,while commercial health insurance and institutional self financing account for only 3.40% of the non mandatory financing.Compared with the average situation of the whole province,the proportion of social health insurance in primary medical and health institutions is significantly lower.Compared with the general hospitals and the overall average situation in the province,the proportion of outpatient treatment cost of primary medical and health institutions is quite high,which is almost complementary to the characteristics of outpatient and inpatient composition of comprehensive medical institutions.In outpatient department,the treatment cost of children aged 0-14 was the lowest(2198.6237 million yuan,12.66%),and the highest was 15-54 years old(10298.8012 million yuan,59.3%);the proportion of respiratory diseases was the highest(6081.9147 million yuan,41.04%),and the proportion of respiratory,circulatory and digestive systems was nearly 75%;in hospitalization,the treatment cost of children aged 0-14 was still the lowest(61.4026 million yuan,1.04%)19%),the highest was the elderly group over 65 years old(3207778000 yuan,62.06%);the first category of circulatory system diseases accounted for 50.92%;there were six categories of outpatient treatment costs in comprehensive medical institutions that accounted for more than 9%,while only three categories in primary outpatient services accounted for more than 75% of the total.According to the financing level of outpatient service and inpatient service,the proportion of direct family payment in outpatient service is very high(72.29%),and the proportion of social basic medical insurance is only 2.54%.Compared with that,the proportion of individual self payment in outpatient service and all types of institutions in comprehensive medical institutions is at least 14 percentage points lower than that in primary outpatient service;the proportion of government financing in inpatient treatment is the highest(39.66%)Compared with comprehensive medical institutions,the ratio of family direct payment was significantly lower(11.86%).Almost all of the household direct payments went into the outpatient service(95.35%).From the financing sources of different diseases,more than 60% of personal cash expenditure included nine kinds of diseases,such as mental and behavioral disorders(60.18%).Among the non compulsory financing schemes for all kinds of diseases,only the commercial insurance for nervous system diseases(8.99%)accounted for a relatively high proportion;among the treatment costs of all types of diseases,the social basic medical insurance accounted for no more than 30%.The average treatment cost per time was 223.05 yuan for pregnancy,childbirth and puerperal related diseases,and 3076.87 yuan for injury or poisoning related diseases in hospital.The proportion of drugs in the average treatment cost per time was 86.05%,which was higher than that of drugs in comprehensive medical institutions 49 to 50% of the specific gravity.(3)The cost of prevention services in primary medical and health institutions in Anhui Province: in 2018,the total cost of prevention services in primary medical and health institutions in Anhui Province was 3.219 billion yuan,accounting for 60.33%of the overall level of prevention costs in the province,of which 898 million were for outpatient departments,accounting for 36.54% and 10.19% of the total fund of prevention services in the province,respectively.The cost of prevention services of primary medical and health institutions in Anhui Province mainly comes from the government financing scheme,accounting for more than 58%,followed by direct family payment(mainly fees)(728 million yuan,22.61%),and enterprise self financing(i.e.institution self financing)(612 million yuan,19.01%).The financing structure of prevention services of primary medical and health institutions in Anhui Province is relatively reasonable.Discussion and suggestions:(1)In the financing of primary medical and health institutions in Anhui Province in 2018,individual direct payment and government program play a leading role;we should improve the multi-channel and omni-directional financing system dominated by government stable investment and social basic medical insurance;clarify and grasp the key disease areas and prevention and control direction in the provincial primary medical service system;strengthen the supervision of government health investment Monitoring and tracking;(2)the age and disease distribution of treatment cost in primary medical and health institutions in Anhui Province is not balanced;reasonably strengthen the economic value of clinical technology of TCM technicians in primary medical and health institutions;build an integrated primary service system to give full play to the guiding role of medical insurance payment;strengthen the undertaking and cooperation between primary medical and health institutions and other institutions(3)the functions of primary medical and health institutions in Anhui province need to be consolidated and expanded;the overall level of health funds per capita of primary medical and health institutions in Anhui province needs to be accelerated;the functional allocation of health expenses of primary medical and health institutions is not reasonable,so we should pay more attention to infectious diseases,public health emergency and traditional Chinese medicine and other fields and increase the extent of financial support Support the integration of primary health care institutions and other institutions,and accelerate the transformation and upgrading to the whole life cycle.