广西医学

目的探讨医疗联合体（医联体）牵头医院因医联体业务引发的财务风险的影响因素。方法采用问卷与专家访谈混合方法，对X省206家医联体牵头医院进行调查，内容包括医联体类型和规模、牵头医院等级、可能因医联体业务而发生的财务风险事件和财务损失事件等。比较不同医联体类型和规模、医院等级的医联体牵头医院之间的财务风险分值，并建立基于秩次的回归模型量化关联效应。结果不同医联体规模及医院等级的医联体牵头医院之间财务风险差异无统计学意义（P>0.05）。不同类型医联体的医联体牵头医院之间财务风险差异有统计学意义，松散型、紧密型、高紧密型医联体的医联体牵头医院财务风险依次增加（P<0.05），紧密型、高紧密型医联体的牵头医院的财务风险水平分别比松散型医联体的牵头医院高89.15%和133.67%。结论医联体整合程度与牵头医院财务风险密切相关。政府相关部门应完善医联体外部监管体系，健全财务管理配套制度，严格审批高紧密型医联体的组建，建立稳定长效的投入机制；医联体牵头医院应加强内部控制与财务风险管理。

Objective To explore the influencing factors for financial risk caused by Medical Treatment Partnerships business in the leading hospital of Medical Treatment Partnerships. Methods A mixed method of questionnaires and expert interviews was adopted to conduct investigation on 206 leading hospitals of Medical Treatment Partnerships in X province, concerning types and scales of Medical Treatment Partnerships, leading hospital grade, the occurrence of financial risk events due to Medical Treatment Partnerships business, and financial loss events, etc. The financial risk scores were compared between leading hospitals of Medical Treatment Partnerships with different types and scales of Medical Treatment Partnerships and hospital grade, and a rank⁃based regression model was established to quantify the correlation effect. Results There was no statistically significant difference in financial risk between leading hospitals of Medical Treatment Partnerships with different scales of Medical Treatment Partnerships and hospital grade (P>0.05). There was a statistically significant difference in financial risk between leading hospitals of Medical Treatment Partnerships with different types of Medical Treatment Partnerships, and financial risks of leading hospitals of Medical Treatment Partnerships of loose, tight, and high⁃tight Medical Treatment Partnership increased in turn (P<0.05); furthermore, financial risk levels of leading hospitals of tight and high⁃tight Medical Treatment Partnerships were 89.15% and 133.67% higher than those of loose Medical Treatment Partnerships, respectively. Conclusion The degree of Medical Treatment Partnerships integration is closely related to financial risk of leading hospital. Relevant government departments should improve the external supervision system of Medical Treatment Partnerships, improve the supporting system of financial management, strictly approve the establishment of high⁃tight Medical Treatment Partnerships, and establish a stable and long⁃term investment mechanism. Leading hospital of Medical Treatment Partnerships should strengthen internal control and financial risk management.