天津市异地就医现状分析及医保对策研究

An analysis on Tianjin residents＇ seeking medical service out-of-hometown and countermeasures of medical insurance

目的了解天津市异地就医流出的人数、流向地区及费用发生现状，为进一步完善天津市异地就医医保问题提供思路与对策。方法对天津市2012年至2014年异地就医人群特征、费用信息和地域分布等进行描述性统计分析，并结合文献分析方法，为解决天津市异地就医问题提出合理化建议。结果2012年至2014年，天津市流出性异地就医登记总人数为109291人，其中退休人群所占比重较大，且异地就医人数呈逐年增长趋势；2012年至2014年，异地就医门诊特殊病种、门诊患者、住院患者的平均费用分别是5740．01元、2219．94元、15763．21元；趋势性检验结果显示，住院费用的增长趋势有统计学意义（F=6．794，P=0．009）；天津市人口外出就医地点主要集中在北京、河北等地区。结论应从国家政策、监管部门和经办机构3个层面出发完善医保管理，实现异地就医联网结算，提高医保服务质量和效率。

Objective Through a survey of the headcount, outflow destination and expenses incurred for those Tianjin residents seeking medical service elsewhere, the study probed into the medical insurance coverage for these people. Methods Descriptive statistics was made to study the characteristics, expense information and regional layout of these people, and rationalization proposals were raised in line with literature review to resolve the problem. Results During 2012 to 2014, the Tianjin residents seeking medical service elsewhere totaled 109 291, of whom the retired accounting for the most, and this trend tended to rise year by year. Within this timeframe, the average cost of those outpatients with special diseases, outpatients and inpatients were 5 740.01 yuan, 2 219.94 yuan and 15 763.21 yuan respectively. The result of Mann-Kendall trend test indicated the trend of hospitalization costs as significant statically（F： 6. 794, P=0. 009）. Their destinations were found to focus on Beijing and Hebei Province. Conclusions Medical insurance management should be improved in terms of national policy, regulators and administrative departments, for the purpose of networked settlement between hometown and destination, and better service quality and efficiency of medical insurance.