老年性白内障医保差额浅析

Analysis on the Medical Insurance Balance of the Senile Cataract

目的:简要分析单病种医保差额的影响因素,以合理控制医疗费用上涨,保障患者的基本医疗服务的同时,提高医院的社会和经济效益。方法:以老年性白内障单病种结算的患者为例,运用多元回归分析法对可能影响医疗费用的因素进行筛选。结果:影响医疗费用因素依次是手术费比例,住院天数,西药费比例,年龄。医保差额受手术费影响较小,西药费、检查费、化验费等实际费用能影响医保差额。结论:降低医保差额,控制医疗费用增长,应以建立科学的临床诊疗路径为突破口,逐步通过医疗保险制度改革来解决。

Objective：To analyze the influencing factors of single illness medical insurance balance to control the rising of the medical expenditure, ensure the basic medical services of the patients and improve the social and economic benefits of the hospital. Methods： Taking senile cataract as the example, this article used the multiple regression analysis to screen the factors which influencing the medical expenditure. Results： The factors influencing the medical expenditure are successively operation cost proportion, hospitalized days, western medicine cost proportion and ages. The medical insurance balance was less influenced by operation cost. And it influenced by western medicine cost, physical and chemical examination cost. Conclusion： To reduce the balance of medical insurance and control the increasing of medical expenditure, we should establish scientific clinic diagnosis and treatment ways and solve the problems gradually through the reform of medical insurance system.