城镇医保患者肺炎住院费用及影响因素分析

Analysis for inpatients cost and medical insurance coverage of pneumonia in China

目的:分析我国肺炎住院患者的直接医疗费用以及不同地域、城市级别、医院级别和医保覆盖情况造成的费用差异。方法:通过机械抽样获得2008年和2009年参保城镇职工和城镇居民医疗保险肺炎住院患者的费用数据,结合卫生年鉴数据进行统计和分析。结果:我国不同地区、不同医保支付系统中肺炎治疗费用有明显差距,省会与直辖市的住院总费用是全国平均水平的3.48倍;城镇居民医疗保险的报销比例与城镇职工医疗保险相比仍然较低。同时肺炎治疗中药品花费比较高,药占比达到60%。结论:我国需要进一步推进临床路径试点,规范肺炎的诊疗流程,合理控制医疗费用的过快增长,扩大基本医疗保险保障力度,合理配置和使用医疗资源,为广大百姓带来福祉。

Objective： To analyze the difference on inpatients＇ direct medical costs of pneumonia among regions, levels of cities, and types of the hospitals. Methods： Systematic sampling was used to collect data on direct medical costs of inpatients with pneumonia and relevant statistics methods were used to analyze the data combining with health statistical yearbook. Results： There was significant difference in direct medical costs among different regions and medical insurance systems. The hospitalization expense of pneumonia in province-capital cities, prefectural-level cities was 3.48 times of the average expense in whole China. The reimbursement rate of basic insurance system for urban residents was much lower than system for urban employees. Drug cost was an important part of pneumonia treatment, which counted about 60% of the total expense. Conclusion： The government needs to further promote the pilot on clinical pathway, standardize the process of diagnosis and treatment of pneumonia and control the growth of health expenditure. It needs to raise the level of basic medical insurance gradually and distribute and use medical resources rationally for the well-being of the people.