综合性医院门诊开展一体化住院前检查服务对患者医疗费用影响的实证研究

Empirical research on the impact of implementing integrated pre-hospitalization examination on patient medical cost in general hospital outpatient department

目的:分析某医院门诊开展一体化住院前检查服务后,患者医疗总费用和住院前后费用的变化规律,模拟参加医疗保险患者的自付费用和医保支付费用构成,为管理部门制定相关政策提供依据。方法:采用回顾性研究,从某医院2013年4月至2014年12月41305例标准收费住院患者资料中筛选符合条件的1928例患者资料,按上海市医疗保险有关规则进行费用模拟,通过多元线性回归和分位数回归分析,比较参加院前检查组患者和非院前检查组患者医疗费用差异。结果:参加院前检查组患者的总费用、模拟自付费用和医保支付费用与未参加院前检查组的差异无统计学意义,其中手术患者的总费用、模拟自付费用和医保支付费用在均值和某些分位数处可能下降。结论:开展一体化住院前检查服务,不会增加患者的医疗费用和医疗保险管理部门的支付压力。

Objectives：To analyze the change of patients＇ total medical cost before and after hospitalization costs with the implementation of pre-hospitalization examination in the hospital outpatient department and to simulate the change pattern of medical insurance patients＇ out-of-pocket expenses and medical insurance payment cost in order to provide reference for decision making.Methods：Totally 1928 patients of 41305 cases of hospitalized patients with standard rate data were selected for the study,eligible from a hospital between April 2013 and December 2013.After simulating the cost according to the relevant rules of the Shanghai medical insurance,multiple linear regression and quantile regression analysis were applied for the comparison of diff erences among the patients in treatment（pre-hospitalization examination） group and in control（traditional examination） group.Results：There was no statistically significant diff erence in the total cost,simulated out-of-pocket expenses and medical insurance fee for patients between treatment group and control group in total medical cost,out of pocket cost and medical insurance cost.It also showed that the surgery patient＇s the total cost,simulated out-of-pocket expenses and medical insurance cost in some quantiles might be decreased.Conclusions：The integration of pre-hospitalization examination does not increase the patient＇s medical expenses burden and the pressure on the medical insurance department.