天津市医保住院患者常见疾病住院及药品费用分析

Analysis of disease and drug expenditures of Tianjin medical insurance inpatient

目的:了解天津市城镇职工住院患者疾病特点及药品费用情况,为有效控制医保住院患者医疗费用及药品费用提供建议。方法:随机抽取天津市城镇职工参保住院患者10%的样本,统计分析住院费用前10位系统疾病和10个常见病种的个人负担及药品费用情况。结果:系统疾病中的肿瘤、呼吸系统疾病和内分泌、营养和代谢疾病和神经系统疾病,以及常见病种中的恶性肿瘤、脑血管病、糖尿病、慢支和肺炎的药品费用比例都超过了个人负担的50%。结论:住院费用前10位系统疾病和常见病种中的大多数应成为今后费用控制的主要对象,需要探索按病种付费、药品目录调整、药品分类给付等手段来控制费用。

Objective： To investigate the disease features and drug expenditures of Tianjin medical insurance inpatient and provide policy reference for controlling the medical and drug costs.Methods： Collecting 10% random inpatient samples from Tianjin Employee Basic Medical Insurance to analyze the out-of-pocket and drug costs of top 10 system diseases and disease entities.Results： The out-of-pocket in such system diseases as tumor,respiratory diseases,endocrine,nutritional metabolic diseases,nervous system disease and such disease entities as malignant tumor,cerebrovascular,diabetes,chronic bronchitis,pneumonia consisted of over 50% of drug expenditures.Conclusion： The top 10 system diseases in inpatient cost and most of the disease entities should be emphasized in controlling the medical cost.Payment by disease-related group（DRG）,drug list adjustment and drug category reimbursement should be adopted to cut down the medical expenditures.