广州市某医院城镇职工住院医保费用影响因素分析

Factors influencing health insurance urban employees'hospitalization expenses in a hospital of Guangzhou

目的:分类比较医疗保险住院病例的住院费用,分析影响医保住院费用的因素,探讨解决医保定额与医疗行为的矛盾。方法:收集某医院2009年的城镇医保所有住院病例,共876例,对于可能的影响因素采用向后回归法进行统计分析。结果:在职与退休、疾病科室分类、是否手术、住院天数、自费比例、药费等,是医保患者住院费用的影响因素。结论:医保定额应按影响因素制定,医院也可通过提高医疗质量减少住院费用。

Objective To classify and compare health insurance patients＇hospitalization expenses,to analyze the factors influencing the expenses,and to discuss the solutions to contradictions between fixed health insurance expenses and medical behavior.Methods All the urban employee medical insurance cases,which totalled 876,were collected in 2009 in a hospital and a statistical analysis was made of the possible influencing factors using backward regression analysis.Results The influencing factors included employment or retirement,classification of disease departments,performance of operations,length of stay,proportion of their own expense,and drug fees.Conclusion The fixed expenses of medical insurance should be decided based on the influencing factors.The hospital could also reduce hospitalization expenses by improving the quality of medical care.