基于“低自付”政策的医保费用分析

Analysis on the Medical Insurance Costs Based on the Policy of “Low Self-Pay”

目的:分析已实行"低自付"病种的医保费用,为"低自付"待遇的进一步开展提供实证依据。方法:以长春市某三甲医院"低自付"患者为研究对象,主要采用描述性分析方法,分析2013年1月至2014年7月"低自付"患者的个人承担费用、实际报销额和理论报销额。结果:"低自付"患者费用明显低于"非低自付"患者,就"低自付"患者自身而言,其理论报销额明显低于实际报销额。通过对患者医保类别分析,受办理条件限制,学生"低自付"患者明显多于城镇居民医保患者。结论:"低自付"待遇的实施已取得良好效果,但仍需继续完善。建议医保部门加大宣传,普及政策知识;进行科学论证,适当扩大"低自付"病种。

Objective:To analyze the medical insurance costs for the implemented'low self-pay'disease and provide empiricalreferences for further implementing the treatment of'low pay'.Methods:Taking'low self-pay'patients in a Tier 3 hospital ofChangchun as the research object,descriptive analysis method was applied to analyze the individual cost,practical reimbursementand theoretical reimbursement for'low self-pay'patients from January 2013 to July 2014.Results:The cost for'low self-pay'pa-tients were significantly lower than the'non low self-pay'.For'low self-pay'patients,the reimbursement amounts were significant-ly lower than the actual reimbursement amount.Through analyzing the health care category of patients,under the restriction of transac-tion condition,the amount of'low self-pay'patients was significantly more than patients under urban residents medical insurance.Conclusion:The implementation of the'low self-pay'treatment had achieved good progress,but still needed further implementa-tion.It was suggested that medical insurance department should make greater efforts to publicize and popularize knowledge of policy;progress scientific verification and appropriately expand'low self-pay'diseases.