住院患者医保费用不合理支出分析

Cause Analysis for the Unreasonable Expenses of Hospitalization Insurance Expenses

目的分析住院患者医保费用不合理支出的原因。方法从某二甲医院报表管理系统抽取不同类别医保患者的住院费用,运用描述性统计方法对住院费用构成进行分析。结果医保费用的不合理支出主要集中在出院诊断为头晕待查、胆囊炎、高血压病、颈椎病、良性肿瘤、腰椎间盘突出症这6类疾病。结论医保费用的不合理支出既有医院的因素,也有医保患者对医疗过度需求的因素,需要医患双方共同提高控制医保费用和节约医保基金的意识,真正将医保基金用在刀刃上。

Objective To analyze the reasons of unreasonable medical expenses of inpatients. Methods The hospitalization expense data of different types of medical insurance patients in a grade - A hospital of second class were selected, and the composition of hospitalization expenses were analyzed by descriptive statistical method. Results Unreasonable expenses of medical insurance expenses mainly concentrated in the diagnosis for dizziness in dispute, choleeystitis, hypertension, cervical spondy]osis, benign tumor, lumbar disc herniation. Conclusion The unreasonable expenses of medical insurance expenses were related to the hospital, but also related to the over demand for health care in patients with medical insurance. Both doctors and patients should improve the awareness of controlling medical insurance costs and saving health insurance funds, then the rational use of medical insurance funds could be truly achieved.