兰州市城镇职工医保2010-2013年住院费用分析

Analysis on Hospitalization Expenses by Medical Insurance During the Year of 2010-2013 for Urban Workers in Lanzhou

通过对2010-2013年兰州市城镇职工医疗保险住院病人住院费用及报销费用信息统计分析发现:职工医疗保险住院率增长了91.79%,总住院费用增长了119.65%,70%以上的住院病人在三级医院住院;2013年比2010年次均住院费用降低了22.24%,平均住院日有所延长,住院实际补偿比有所降低;住院费用中药物费用所占比例为40%左右。因此,兰州市城镇职工医疗保险应建立门诊统筹,由医保机构加强对定点医院的监管,并建立双向转诊制度,改进医保支付方式。

Objective： To further improve the medical insurance system for urban workers of Lanzhou. Methods： Analyze the expenses of hospitalization and reimbursement for the insured urban workers during the year of 2010 to 2013. Results： From 2010 to 2013, hospitalization rate of the insured population has been increased by 91.79%, the total hospitalization expenses has been increased by 119.65%, and more than 70% of hospitalized patients treated in tertiary hospitals. Comparing with those of 2010, the average hospitalization expenses has been decreased by 22.24%, but the average hospitalization days have been prolonged, and the actual hospitalization compensation ratio has been decreased in 2013. The proportion of drug costs in hospitalization expenses is about 40%. Conclusion： Overall insurance planning for out-patients should be established in the medical insurance system for urban workers of Lanzhou; medical insurance institutions should intensify supervision on designated hospitals; the two-way referral system should be established; medical insurance payment methods must be improved.