某院2011年-2014年医保患者次均住院费用控制分析

A Control Analysis on the Average Hospitalization Expenses of Medical Insurance Patients of a Hospital from 2011 to 2014

目的比较某三甲医院2011年-2014年市医保、区医保、兵团医保以及新农合患者均次住院费用,为控制次均住院费用不合理增长提供科学依据。方法从某三甲综合性医院获取数据,运用描述性统计方法对不同医保患者次均住院费用及其费用构成情况进行描述分析。结果兵团医保均次住院费用最高,2011年-2014年的次均住院费用为16870±7788元;并且四类医保的次均住院费用呈逐年增长的趋势,新农合均次住院费用年增长率最高,达到98.06%;四类医保住院费用构成结构中,药品费比例均高于30%,技术性收费远低于药品费所占比例。结论各社保应该采取措施,降低次均住院费用,避免过度医疗,特别是兵团医保和新农合要加强监管,控制住院费用的不合理增长;医疗机构需采取措施降低药品和其它费用(材料)的构成比例,提高医疗含金量,减少医保基金的浪费。

Objectives To compare the average hospitalization expenses of patients with different types of health care patients including city medical insurance, region medical insurance, corps medical insurance as well as the new rural cooperative medical insurance of a Grade A and Tertiary Hospital from 2011 to 2014, and provide scientific evidence for the controlling of unreasonable growth of average hospitalization expenses. Method To get data from a Grade A and Tertiary Hospital,descriptive statistics method was adopted to describe the average hospitalization expenses of different types of health care patients as well as the composition of the expenses. Results Corps of health care had the highest hospitalization expenses, 2011-2014 times of hospitalization expenses for 16870 ＋ 7788 yuan.And the average hospitalization expenses of all the four types of health care had the trend of increasing year by year,the expense of new rural cooperative medical insurance patients had the highest annual growth rate, which reached 98.06%. In the four kinds of hospitalized expense composition structure, the proportion of drugs cost were all higher than 30%, the technical charge was far lower than the proportion of drugs. Conclusions The social security should take measures to reduce the average hospitalization expenses, avoid excessive medical treatment, especially the corps and new rural cooperative medical insurance should strengthen the supervision and control of hospitalization expense, improve medical value and reduce the waste of medical insurance fund.