医保患者住院费用实行总额预付制前后相关指标的比较

A Comparison of Total Amount Related Index Before and After the Application of Prospective Payment System among Medical Insurance Patients

目的通过分析我院医保患者住院费用相关指标,比较实行总额预付制前后指标变化。方法采集2011年7月-2012年4期间住院的本市职工基本医疗保险人员作为观察组,再选择之前十个月的参保人员作为对照组,分析实施总额预付制前后,医保住院费用指标的变化。结果实施了总额预付制后,在住院总人数增加的情况下,平均住院日、药占比、自费比的费用减少,P值分别为0.001,0.003,0.015,有统计学意义;检查费比增加,P值为0.001,有统计学意义;次均费用虽有降低,但无统计学意义。结论实行总额预付制可以控制医保费用;同时也会有不良因素存在。

Objective To make a comparison of total amount related index before and after the application of prospective payment system by analyze the cost related index of medical insurance patients in our hospital. Methods Took the patients of our city who have basic staff medical insurance in our hospital from July 2011 to April 2012 as observation group, then chose the insured patients of former ten months as control group, finally analyzed the change of total cost before and after the application of prospective payment system. Results Under the condition of increased total number of patients, the average days in hospital, medicine ratio and self- supporting ratio were decreased after the application of the system, P were 0.001, 0.003 and 0. 015 respectively and had statistical significance, the ratio of examination fee was increased with its P was 0.001, had statistical significance, the second average fee was decreased either, but had no significance. Conclusion The cost of medical insurance could be controlled with the application of prospec- tive payment system, but some badness factors also existing.