新疆某三甲医院常见疾病医保与自费患者住院费用的差异分析

Analysis on Four Kinds of Common Diseases Hospital Costsbetween Medical Insurance and Self Financed Patientsina Xinjiang Tertiary Level Hospital

目的分析常见疾病医保和自费患者的住院费用现状及影响因素,为社保机构和医疗机构制定合理有效的费用监管措施提供参考依据。方法资料来自新疆某三甲综合性医院住院2014全年HIS系统中的2型糖尿病、脑梗死、冠状动脉粥样硬化性心脏病、急性化脓性阑尾炎等4种常见疾病,共计2564例。采用非参数检验对医保与自费患者的费用构成对比分析,利用多元线性逐步回归对住院费用影响因素进行分析。结果 2型糖尿病的住院费用、住院天数在医保和自费患者间有显著性差异,医保患者的住院费用10 975元、住院天数11.2天均高于自费患者7862元、7.5天。急性化脓性阑尾炎的住院费用在医保和自费间经检验有统计学差异,医保患者的住院费用15 041元高于自费患者的9108元。脑梗死医保患者的住院天数16.3天,高于自费患者的11.8天(P<0.05)。4种疾病的费用构成中,药品费所占比重较高,占到了住院费用的30%以上;影响医保和自费患者的住院费用的因素从大到小依次是住院天数、住院次数和年龄。结论医保与自费患者的住院费用存在差异,医保患者比自费患者消耗了更多的医疗资源。通过医疗机构内部费用监控、加强合理用药监管、优化薪酬分配体系,提升医护人员技术价值的方式均可控制住院费用的增长。

Objective To analyze the affecting factors on hospitalization expenses for medicare insurance and self financed patients, and provide reference for social security and medical institutions to develop reasonable and effective cost control measures. Methods Information from a top three general hospital HIS system in Xinjiang for the year of 2014, Using non-parametric tests to analyze on hospital costs for medicare patients at their own expense. Multivariate linear regression analysis on factors affecting hospitalization expenses. Results The hospitalization expenses and hospitalization days of type 2 diabetes were significantly different between medical insurance and self-paying patients. The hospitalization cost of medical insurance patients was 10, 775 yuan, and the number of days of hospitalization was 11.8 days. Acute suppurative appendicitis hospitalization costs in health care and serf-financed see the test was statistically significant, medical insurance patients hospitalization costs 15041 yuan higher than 9108 yuan at their own expense patients. The hospital stay of patients with cerebral infarction was 16.3 days, which was 11.8 days （P 〈0. 05）. 4 costs constitute a kind of disease, Drug costs are the main components of the cost of hospitalization, accounted for over 30% of the hospitalization expense, and factors affecting hospitalization expenses have diabetes hospital days, number of hospitalizations and age. Conclusion Hospital expenses have significant differences between Medicareinsurance and self financed Patients. Medicare patients consume more health care resources than private. Hospital internal cost control, rational use of drugs to strengthen supervision, salary distribution to optimize and enhance the value of medical technology the way can control the growth of hospital costs.