城镇居民医保住院患者个人负担分析

Analysis on the Individual Burden of Hospitalized Patients with Urban Residents Insurance

方法 :利用"全国基本医疗保险参保患者医疗服务利用调查"数据,分析城镇居民医保住院患者个人负担。结果 :2010-2012年间居民住院享受待遇人次快速上升。2012年,当次住院费用在5万元以上的有13万人次,约占0.9%,年龄越大发生大额住院费用的几率越高。个人负担占比随着医疗费用上升而上升,5万元以上患者的基金支付比例为43%。有超过100万人次的居民参保患者当次住院费用即超过了WHO设定的灾难性支出水平。个人负担较高的病例自费费用和自付费用对个人负担均起到重要影响,高值耗材费用的影响突出。

Methods Using National Basic Medical Insurance Patients＇ Medical Service Utilization Survey Data to analyze the individual burdens of hospitalized patients with urban residents insurance. Results During the year of 2010 to 2012, the number of person-hospitalization treatment has been rapidly increased. In 2012, there were 130,000 people （about 0.9%） with over 50,000 yuan hospitalization expenses per-time; the older the age, the greater the chance of high hospitalization cost. Individual payment proportion rose with medical costs. For 50,000 yuan and more medical cost, the insurance fund paid only 43% of them. There were over 1 million urban residents patients with hospitalization expense exceeding WHO disastrous spending levels. The expense of services not covered by basic medical insurance and out-of-pocket costs have important impacts on personal cost, whereas, high value medical consumable material have a dominant influence.