定点医疗管理下的门诊统筹服务利用和费用分析

Utilization and expense of outpatient service under medical insurance contracting management

目的:探讨定点医疗管理下,普通门诊统筹办法对参保人和定点医疗机构的影响。方法:采用Excel2003和SPSS17.0软件对数据进行处理和分析。结果:2009年度广州市某医院门诊城镇职工的年度人均限额只用到人均限额结算标准的35.0%,城镇居民的年度人均限额只用到人均限额结算标准的20.94%;门诊次均费用相对稳定,但总体呈逐月上升趋势;次均费用与医保基金支付比重及统筹基金支付比重有显著相关关系。结论:定点医疗管理办法提高了居民的门诊服务利用,但是普通门诊的统筹支付比例还有待进一步提高。

Objectives： To explore the effects of general outpatient pooling measure on both insured and contracted hospital under medical insurance c, ontracting management. Methods： Data were analyzed by Excel2003 and SPSSI7.0. Results： Urban employee＇ s annual average compensation payment only 35.0% to annual average payment standards and that of urban resident only 20.94% in a hospital in Guangzhou in 2009. The average outpatient service expense was relatively stable but increased month by month. Average outpatient expense has a significant correlation with eopayment of medical insurance funds and medical pooling funds.