某院实行医保总额预付制对医疗支出的影响

Influences of Applying Amount Budget System on Medical Expenses in a Hospital

目的分析医保总额预付制对医疗各项支出的影响。方法利用上海市某三级甲等综合医院2008—2010年所有单一病种住院患者的数据,应用多元回归研究医保预付制与患者的相关支出水平的关系。结果医保总额预付制减少了大型检查、普通检查和化验的数量;降低了普通检查费用、自费药品费、手术材料费、检查费、中草药费等;提高了医保药品费、住院费、诊疗费、治疗费、护理费等;总体而言,医保总额预付后,总费用却上升了6.6%。相对于自费患者,预付内患者的总费用低了4.6%。结论医保总额预付制能在一定程度上控制医疗支出,但不能统一地降低患者医保各项支出,该制度和其他配套管理措施亟需完善。

Objective To analyze the influences of amount budget system on the expenses of health insur- ance. Methods The inpatients information was used from a third - grade class - A hospital in Shanghai within the time range of 2008 - 2010, and the relationship was investigated between amount budget system and the expenses of health insurance. Results The amount budget system reduced the number of examinations and laboratory tests, decreased the expenses for ordinary examinations, self- paid drugs, operation materials, TCM etc. , while in- creased the expenses for insurance - paid drugs, hospitalization, diagnosis, nursing etc ; in a general scale, medi- cal expenses rose 6.6 percent as a result of applying the amount budget system. And compared with uninsured pa- tients, the insured enjoyed a 4.6 percent down of medical expenses. Conclusion the amount budget system could reduce some medical expenses. Efforts should be made to improve the current amount budget system and related regulations.