城镇基本医疗保险对恶性肿瘤患者住院治疗及费用的影响分析

Impact of the urban basic health insurances on treatment and expenses of insured in patients with cancer

目的:恶性肿瘤患者经济负担较重,本研究以郑州市为例,探索不同医疗保险类型对恶性肿瘤治疗及其费用的影响。方法:随机抽取郑州恶性肿瘤医保患者600名,统计分析其住院费用影响因素。结果:医保种类、就诊医疗机构级别、住院日、病种等对次均住院费用有影响;治疗费用结构上,两类保险患者无明显差异,但各分类费用职保患者均较高。结论:职工医疗保险的保障力度较居民医保大,职保患者各类费用整体偏高,但不影响诊疗方案的选择。应加大政府投入,减少卫生服务利用差异,制定符合国情的诊疗规范,通过加大监管力度,改革支付方式等减少道德风险造成的卫生资源浪费。

Objective：The economic burden of patients with cancer is relatively heavy.This paper took Zhengzhou as an instance.It investigated and analyzed the impact of the two basic insurance schemes on treatment expenses of patients with cancer.Methods：Treatment records of 600 cancer patients were randomly selected.Statistic analysis was conducted on influencing factors of the inpatients expenses.Results：Significant influencing factors on in-patients expenses included types of health insurance,the level of the hospital,the length of hospital stay and the subdivision of cancer.There was no significant difference between two health insurances in the structure of expenses,but patients of Urban Employee Basic Health Insurance（URBMI） had much more higher classified expenses than those of Urban Resident Basic Medical Insurance（URBMI）.Conclusion：UEBMI had a better benefit package than URBMI.More funds from government should be poured in to fill the gap between two basic health insurance schemes and eliminate the moral hazard which might cause the unfairness of health service utilization and the waste of health resources.