人工划价收费模式在门诊伤口换药室中的应用

Study on the Effects of Artificial Pricing System in Wound Care Clinic

目的分析现行的人工划价收费模式在伤口换药室的应用情况。方法回顾性分析比较北京某三级甲等医院5名伤口门诊护士2013年1月一5月，采用人工划价收费模式进行划价收费的情况。共划价1012换药例次，其中自费患者448例次，医保患者372例次，军队患者免费（军免）192例次。结果从总体水平看，在人工划价收费的模式下，3类费别患者的总体平均换药收费有所不同，但差异无统计学意义（P〉0．05），其中军免患者换药总平均收费最高，医保患者换药总平均收费最低。5名护士在自费和军免患者的平均收费上与总体平均收费之间无明显差异（P〉O．05），但在医保患者的收费上则呈现2低3高的现象：其中2名护士的患者收费低于总平均收费1～2元，差异有统计学意义（P〈0．05）；而3名护士的患者收费则高出总平均收费1～6元，差异有统计学意义（P〈0．05）。从单个个体看，每名护士在3类不同类别的患者平均收费中都有不同，但组间比较差异无统计学意义（P〉0．05），仅有1名护士的军免患者平均收费高出该名护士的医保患者平均收费10元，差异有统计学意义（P〈0．05）。结论人工划价收费模式具有太多的不确定性和人为性，在当前医疗形势下，存在安全隐患，应积极探索一种更适合伤口门诊的标准划价收费模式。

Objective To analyze the application of artificial pricing system in wound care clinic. Methods We retrospectively analyzed the pricing and charging by five nurses with artificial pricing system between January and May 2013 in the wound care clinic ofa grade-A level-three hospital in Beijing. Among the 1012 times of pricing, 448 were out- of-pocket cases, 372 were insurance cases and 192 were military cases. Results Generally, the average fee of the three types of cases had no significant difference （P 〉 0.05）. The military case was a little higher than the other two kinds of cases, and the cost of insurance cases was the lowest of all. There were no significant difference between the average price of out-of-pocket cases and military cases, and the general average price, but there was some differences in the aspect of insurance pricing. In the insurance cases, two nurses＇ pricing was significantly lower and one significantly higher than the general average （P 〈 0.05）. Conclusion The artificial pricing system is unstable and uncertain, and it has high risk on patients＇ safety in wound care clinic.