[1]曲建卫张析哲彭宏宇王志华周志强咸本松.某院综合改革对医疗费用结构与直接医疗经济负担的影响研究[J].中国卫生质量管理,2020,27(03):43-46.
　QU Jianwei,ZHANG Xizhe,PENG Hongyu,et al.Influence of Comprehensive Reform on the Structure of Medical Expenses and the Economic Burden of Direct Medical Care in A Hospital[J].Chinese Health Quality Management,2020,27(03):43-46.

点击复制

某院综合改革对医疗费用结构与直接医疗经济负担的影响研究

《中国卫生质量管理》[ISSN:1006-7515/CN:CN 61-1283/R] 卷: 第27卷期数: 2020年03期页码: 43-46 栏目: 医疗质量出版日期: 2020-05-28

Title:: Influence of Comprehensive Reform on the Structure of Medical Expenses and the Economic Burden of Direct Medical Care in A Hospital

作者:: 曲建卫张析哲彭宏宇王志华周志强咸本松; 内蒙古医科大学赤峰临床医学院

Author(s):: QU Jianwei; ZHANG Xizhe; PENG Hongyu; et al; Chifeng Clinical Medical College of Inner Mongolia Medical University

关键词:: 医改; 医疗保险; 医疗费用结构; 直接医疗经济负担

Keywords:: Medical Reform; Medical Insurance; Medical Cost Structure; Direct Medical Economic Burden

分类号:: R197.3

文献标志码:: B

摘要:: 目的调查公立医院综合改革对参保住院患者医疗费用结构和直接医疗经济负担的影响，为有效控制公立医院医疗费用不合理增长，减轻群众医疗费用负担提供实证依据。方法收集某院2015年-2018年即时结报的参保住院患者医疗费用与基本医疗保险报销数据。采用结构变动度分析方法对参保住院患者医疗费用结构进行对比分析。采用方差分析方法对各年度间参保住院患者医疗负担费用差异性进行分析。结果改革后，人均药品费用呈逐年递减趋势，人均治疗费用呈逐年递增趋势。2015年-2018年人均检查费用呈逐年上升趋势，但2016年-2017年和2017年-2018年增幅低于2015年-2016年。2016年-2017年人均耗材费用降低，而2017年-2018年人均耗材费用增加。改革后，人均医保负担费用逐年增加，人均患者负担费用和人均自付比例逐年下降。此外，2017年人均医疗总费用较2016年下降，而2018年人均医疗总费用较2017年增加。结论人均药品费用与人均耗材费用仍是人均医疗总费用的主要组成部分，医疗费用结构仍需进一步优化，政府管理部门应逐步加强药品和耗材监管。人均自付比例虽呈降低趋势，但与医改设定目标存在一定差距，仍需进一步深化医保改革。

Abstract:: ObjectiveTo investigate the impact of the comprehensive reform on the medical expenses structure and direct medical economic burden among insured inpatients, and provide an empirical evidence for effectively controlling the unreasonable growth of medical expenses in public hospitals and reducing the burden of medical expenses.MethodsThe medical expenses and basic medical insurance reimbursement data for inpatients in a hospital from 2015 to 2018 were collected. The structural variation analysis method was used to compare the medical cost structure of insured inpatients. The analysis of variance method was used to analyze the difference in the medical expenses burden of insured inpatients during each year.ResultsAfter the reform, the per capita drug cost was decreasing year by year, and the per capita treatment cost was increasing year by year. From 2015 to 2018, the per capita inspection expenses showed an increasing trend, but the growth rate of 2016-2017 and 2017-2018 was lower than that of 2015-2016. From 2016 to 2017, the per capita consumption of consumables decreased, while from 2017 to 2018, the per capita consumption of consumables increased. After the reform, the per capita cost of medical insurance increased year by year, and the per capita cost of patients and the per capita self-payment ratio decreased year by year. Furthermore, the total medical expenditure per capita in 2017 was lower than that in 2016, while the total medical expenditure per capita in 2018 was higher than that in 2017.Conclusion The per capita drug cost and per capita consumable cost were still the main components of per capita total medical cost. The medical cost structure still needed to be further optimized, and the government administration department should gradually strengthen the supervision of drugs and consumable cost. Although the per capita self-payment ratio showed a decreasing trend, there was a certain gap with the set goal of the medical reform, and the medical insurance reform still needed to be further deepened.

参考文献/References:

［1］刘峥,高倩倩,王培承,等.基于结构变动度的新型农村合作医疗住院病人费用流向分析及政策探讨［J］. 中国卫生经济，2016,35（7）：23-26.

相似文献/References:

[1]李绍刚,王春玉,陈晓红,等.新加坡医院管理经验与启示[J].中国卫生质量管理,2015,22(06):119.
[2]张晗张红霞靳斌宋宁.总额预付制实施前后北京市门诊医保患者次均费用对比分析[J].中国卫生质量管理,2018,25(01):21.[doi:10.13912/j.cnki.chqm.2018.25.1.08]
[3]黄超陈耀龙蒋帅王小琴王强.深化医改背景下我国临床实践指南规范化发展的探讨[J].中国卫生质量管理,2018,25(04):43.[doi:10.13912/j.cnki.chqm.2018.25.4.14]
[4]周海龙.上海某二级医院医联体的建设与思考[J].中国卫生质量管理,2018,25(06):120.[doi:10.13912/j.cnki.chqm.2018.25.6.35]
[5]孙宇航王萍.国内外罕见病患者医疗保障现状探讨及启示[J].中国卫生质量管理,2019,26(03):141.[doi:10.13912/j.cnki.chqm.2019.26.3.39]
[6]李雅琳熊蔓陆烨高华斌.云南省医疗机构DRGs-PPS支付改革试点效果分析[J].中国卫生质量管理,2019,26(05):52.[doi:10.13912/j.cnki.chqm.2019.26.5.16]
[7]伍勇童利群.统筹支付下医保支付改革的实证分析[J].中国卫生质量管理,2020,27(01):57.[doi:10.13912/j.cnki.chqm.2020.27.1.15]
[8]杜会征李慧焦卫平.某院异地医保结算现状分析[J].中国卫生质量管理,2021,28(10):51.[doi:10.13912/j.cnki.chqm.2021.28.10.14 ]
　DU Huizheng,LI Hui,JIAO Weiping.Analysis of the Status Quo of Settlement of Remote Medical Insurance in a Hospital[J].Chinese Health Quality Management,2021,28(03):51.[doi:10.13912/j.cnki.chqm.2021.28.10.14 ]
[9]安磊么莉冯晶晶詹磊磊尚文涵李伟王凯.美国医保支付制度改革对我国康复护理服务的启示[J].中国卫生质量管理,2022,29(04):9.[doi:10.13912/j.cnki.chqm.2022.29.4.03 ]
　AN Lei,YAO Li,FENG Jingjing.American Medical Payment System Reform and Its Enlightenment for Development of Rehabilitation Nursing Services in China[J].Chinese Health Quality Management,2022,29(03):9.[doi:10.13912/j.cnki.chqm.2022.29.4.03 ]
[10]陈烨沈颖洁彭红.医保与商保融合的健康管理组织模式探讨[J].中国卫生质量管理,2023,30(08):71.[doi:10.13912/j.cnki.chqm.2023.30.8.15 ]
　CHEN Ye,SHEN Yingjie,PENG Hong.Health Maintenance Organization Model of the Integration of Medical Insurance and Commercial Insurance[J].Chinese Health Quality Management,2023,30(03):71.[doi:10.13912/j.cnki.chqm.2023.30.8.15 ]

更新日期/Last Update: 2020-05-28