医疗保险实行单病种定额结算的成本—效果分析

Cost-effectiveness Analysis of Ration Balance on Single Disease by Medicare

目的:评价医疗保险实行单病种定额结算的经济效果。方法:调查了5种病种860例医疗保险病例,根据其结算方式的不同,将其分为单病种结算组和按项目结算组,统计分析各组的医疗费用支出、治疗成本和效果,运用成本—效果分析方法进行回顾性分析评价。结果:单病种结算组的人均住院床日、人均医疗费、人均个人负担额、总成本和成本—效果比均低于按项目结算组,两组治疗效果无显著差异(P>0.05)。结论:认为单病种定额结算方案相对于按服务项目结算方案有较好的经济效果。

Objective Evaluation the economic effect of ration balance on single disease by medicare. Method 5 diseases including 860 hospitalization insurance cases which were classified as single or project disease group according to different balance method were investigated. Result The average day being in hospital, average personal fee for service, average personal charge, total cost, and ratio between cost versus effect of single disease were all low than project group, there was no significant difference （P〉0.05）. Conclusion The economic effect of ration balance on single disease is relatively better than balance according to service project.