Abstract: Objective　To analyze the status of hierarchical diagnosis and treatment（HDT） covered by the New Rural Cooperative Medical Scheme （NRCMS） in Huining County，Gansu Province，providing suggestions for the improvement of HDT in this county.Methods　From October 2016 to November 2017，we collected 246 461 records of hospitalization expenses reimbursed by the NRCMS in Huining County，Gansu Province during 2012 to 2016.We compared the rate of seeking inpatient healthcare in and outside of this county，average cost and length of a hospitalization，and average real reimbursement for a hospitalization before and after 2014 （the implementation of HDT） in this county.Results　After the implementation of HDT，the overall rate of seeking inpatient healthcare within the county increased significantly〔79.18%（131 275/165 792） vs 77.04%（62 134/80 655），χ2=147.64，P<0.01〕.The average cost of a hospitalization declined significantly in township health centers within the county and in county-level medical institutions outside the county，but increased obviously in county-level medical institutions and all medical institutions within the county and in hospitals at municipal，provincial and above levels as well as all medical institutions outside the county（P<0.05）．The average real reimbursement for a hospitalization decreased substantially in township health centers within the county，county-level medical institutions，hospitals at municipal，provincial and above levels as well as all medical institutions outside the county，but increased significantly in county-level medical institutions and all medical institutions within the county（P<0.05）．The median length of hospitalization in medical institutions within the county differed significantly before and after the implementation of HDT〔7（5，11）d vs 7（5，10）d，Z=21.483，P<0.05〕.Conclusion　The implementation of HDT in Huining county promoted the reasonable flow of inpatients，improved the service efficiency and controlled the cost of hospitalization in medical institutions，which is contributive to reducing the patients' medical burden.

Key words: Fees, medical；Length of stay；Hierarchical diagnosis and treatment；New rural cooperative medical system

摘要： 目的　评价甘肃省会宁县新型农村合作医疗制度（以下简称“新农合”）分级诊疗政策运行效果，为进一步完善该县分级诊疗政策提供参考及建议。方法　2016年10月—2017年11月，收集2012—2016年会宁县新农合住院患者246 461条报销记录，比较2014年分级诊疗政策实施前后县内外就诊比例、次均住院费用、次均实际补偿费用、住院时间。结果　分级诊疗政策实施后新农合住院患者县内就诊比例为79.18%（131 275/165 792），高于分级诊疗政策实施前的77.04%（62 134/80 655，χ2=147.64，P<0.01）。分级诊疗政策实施后，县内中心卫生院次均住院费用低于实施前，县级、县内医疗机构总体次均住院费用高于实施前，县外县级医疗机构次均住院费用低于实施前，市级、省级及以上、县外医疗机构总体次均住院费用高于实施前（P<0.05）。分级诊疗政策实施后，县内中心卫生院次均实际补偿费用低于实施前，县级、县内医疗机构总体次均实际补偿费用高于实施前，县外县级、市级、省级及以上、县外医疗机构总体次均实际补偿费用低于实施前（P<0.05）。县内患者分级诊疗政策实施前、后中位住院时间分别为7（5，11）、7（5，10） d，差异有统计学意义（Z=21.483，P<0.05）。结论　甘肃省会宁县分级诊疗政策促进了新农合患者合理分流，住院患者医疗费用控制初显成效，卫生服务效率有所提高，在一定程度上减轻了患者的就医负担。

关键词: 费用, 医疗；住院时间；分级诊疗；新型农村合作医疗