总额预付制下某三甲医院住院医保费用管理现状

Current Management Situation of Medical Insurance Cost of Inpatients under Total Prepayment System in a Hospital of Class Three,Grade One

目的分析医院医保费用增长的情况,为医院医保费用管理提供数据。方法从新疆某三甲医院系统收集2013—2015年医保患者住院信息数据,内容包括姓名、科室、住院天数、住院总费用、统筹费用、个人支付费用等,分析近3年某三甲医院医保费用的年均增长率,采用对不同年份的单因素方差分析,描述各年份住院均次费用及大额患者现况。结果 2015年较2013年,该三甲医院的住院人数、总费用、医保统筹费用、人均费用均呈增长趋势,增长率分别为10.50%、18.60%、3.42%、7.34%,通过单因素分析认为不同年份之间的住院总费比较差异有统计学意义(F=4.46,P=0.01),该院对不同医保均次费用控制效果不同,区级均次费用控制效果较明显,年均增长率0.93%,同时大额费用比例较高(占23.42%)。结论提出医保费用增长的原因,通过分析为医院医保费用管理提供数据支持,提出医院合理控制医疗费用的建议。

Objective：To analyze the growth of hospital medical insurance and make it a base for hospital medical insurance management. Method：The authors collected the information data on hospitalized patients with medical insurance in a Xinjiang hospi- tal of class three, grade one from 2013 to 2015, which covers names, departments, days of hospitalization, total expense for hospitali- zation,the whole cost, and individual pay cost. They analyze the annual average growth in the 3 years, and describe hospitalization cost each time each year and the present situation of the patients of large expense with one-way analysis of variance in different years. Result： The growing rates of hospitalization, total expense, the over-all medical insurance cost, cost per capita increase to 10. 50%, 18. 60%, 3.42 %, and 7.34% respectively. The single factor analysis shows that there is statistical meaning （ F -- 4. 46, P = 0. 01 ） in the comparative differences for the total hospitalization cost in different years. The controlling over all time costs covered in medical insurance differs. The annual growing rate of all time cost at regional level is 0. 93% ,and the large cost ratio is higher,accounting for 23.42%. Conclnsion：In this paper, the reasons for the growing medical insurance cost are presented, and the analyzed data support of medical insurance management and the suggestions for reasonable control over medical expenses in hospitals are put forward.