总额预付下银川市各类医疗机构医疗费用分析

Analysis of Medical Expenditure in Different Medical Institutions under Total Prepayment in Yinchuan

目的:研究总额预付制对控制医疗费用过度增长的有效性,从而推动预付制的全面实行,保证医保资金收支平衡。方法:采用文献复习、定量数据收集方法,对资料进行描述性统计分析。结果:银川市二级医院、三级医院实行总额预付前后平均住院次均费用变化不大,二级医院平均下降2.95%,三级医院平均增长1.75%;但二者透支很大,二级医院平均透支61.55%,三级医院平均透支49.33%。结论:实行总额预付伊始,医保中心和医院都没有足够的思想和比较成熟的测算方案来应对总额预付下结构控制的问题,因而出现基金提前预支、透支、拒收病人等现象,导致对控制医疗费用不敏感。建议:科学制定总额;积极探索总额预算下,按病种付费、按单元付费;建立以参保人满意度为核心、同行评议为补充的医疗服务行为评价体系;建立医院激励约束机制。

Objective： To analyze the effectiveness of total budget system on controlling the over-increasing medical expendituro, so as to promote the implementation of prepayment system and ensure the payment balance of medical insurance funds. Methods： IJteraturo review and quantitative data collective method are used for description analysis methods. Results： There are no significant change of the average expenditure among the third and second grade hospitals. The second grade hospitsd decreased by 2.95% and the third grade hospital increased by 1.75%; but the overdrafts are significantly, that of the second grade hospital is 61.55% and that of the third grade hospital is 49.33%. Conclusion： A1 the beginning of total prepayment, the medical insurance centers and hospitals have not got enough thinking and comparative mature estimation scheme to face the problems of construction eontrol under the total prepayment. Therofnro, prepayment, overdraft and rejection of funds appeared which leads the insensitivity of controlling medical treatment cost. Suggestion： To design total payment system scientifically; to exploro pay by desease and by unit based on total budget; to set up the medical service behavior evaluation system centered with the satisfaction of the insurers and the supple of peer reviews and to build incentive control mechanism of hospitals.