两种支付方式对不同医保制度恶性肿瘤患者住院费用影响分析

Impacts of the two payment packages on the hospitalization expenses of cancer patients covered by two medi- cal insurance schemes

目的分析按项目支付和限额支付方式下恶性肿瘤患者的住院费用，探索不同医疗保险支付方式对恶性肿瘤治疗费用的影响。方法从郑州市和福州市的医疗保险数据库中，各随机抽取恶性肿瘤医保患者600名，统计分析其住院费用及其影响因素。结果在按项目支付方式下，职工医保患者的费用水平高于居民医保患者，人均住院费用分别为32747．70±32035．01元和23035．83士22875．65元；而在限额支付方式下，两类医保患者住院费用差异不大，人均住院费用分别为66043．41士47562．09元和66576．54±73417．29元。结论不同医疗保险的保障水平差异客观存在。在按项目支付方式下，保障的差异体现在次均费用的差别上；而在限额支付方式下，两类医保人群费用差异不大。建议合理利用支付方式，避免和减少由于医疗保障水平不同而造成的卫生服务利用的相对差异。

Objective To analyze the hospitalization expenses of cancer patients covered with by- item payment and quota payment packages, and probe into the impacts on such expenses for the two payment packages. Methods Inpatient records of 600 cancer patients were sampled by random from the medical insurance databases of Zhengzhou and Fuzhou to learn their hospitalization expenses and impact factors. Results Under the by-item payment package, the expenses of urban workers＇ medical insurance were found higher than those of urban residents＇ medical insurance, with a per capita expense of RMB 32747. 70 ± 32035. 01 and 23035. 83 ±22875. 65 respectively. Under the quota payment package however, there were no significant differences between expenses of the two kinds of inpatients, with a per capita expense of RMB 66043.41 ± 47562.09 and 66576.54 ± 73417. 29 respectively. Conclusion There are gaps of reimbursement level between the two basic insurance schemes, which may not disappear in a short time. Under the by-item payment package, the gap exists in the difference of per- reimbursement amount; under the quota payment package, the gap is negligible between the two populations under different insurance schemes. It is recommended to make reasonable use of these different payment schemes to minimize the relative gaps in medical service accessibility caused by the difference in reimbursement level.