我国医疗保险基金支出的影响因素及建议

Study on the Influencing Factors of Chinese Medical Insurance Fund Expenditure and Suggestions

目的探讨我国医疗保险基金支出的影响因素,并针对医疗保险基金支出提出建议,为医疗保障制度改革提供基础数据。方法查阅2004—2014年《中国统计年鉴》,统计各年城镇职工基本医疗保险基金支出、城镇居民基本医疗保险基金支出、新型农村合作医疗保险基金支出、人均GDP、城镇化率数据。查阅2004—2014年《中国卫生统计年鉴》,统计各年年末总人口、性别比、65岁及以上人口所占比例、卫生机构数、医疗卫生机构住院患者手术人次、医院平均住院日、平均每所公立医院医疗收入、医院住院患者人均医药费用数据。采用Pearson相关性分析和多元逐步回归法分析人均医疗保险基金支出的影响因素。结果多元逐步回归分析结果显示,平均每所公立医院医疗收入对人均医疗保险基金支出有影响,平均每所公立医院医疗收入每增加100元,全国平均每人医疗保险基金多支出6.9元,人均医疗保险基金支出变化的99.6%可以由平均每所公立医院医疗收入解释。Pearson相关性分析结果显示,平均每所公立医院的医疗收入与性别比和医院平均住院日呈负相关,与人均GDP、65岁以上人口所占比例、城镇化率、卫生机构数、医疗卫生机构住院患者手术人次、医院住院患者人均医药费用呈正相关(P<0.05)。结论控制医疗保险基金支出的关键在于控制公立医院的医疗收入。为此,需大力增加政府财政补助,减轻医院对医疗收入的依赖;改革现行医保结算模式,加强医保基金的监督管理;加强基层医疗机构建设,真正落实分级诊疗制度;真正贯彻预防为主的卫生工作方针,落实基层医疗机构治未病措施。

Objective To explore the influence factor of medical insurance fund expenditure in China, and put forward the measures to expenditure of medical insurance fund, provide basic data for the medical security system reform. Methods A review of ＂ Statistical yearbook of China＂ from 2004 to 2014 , statistics the data of the basic medical insurance fund expenditures for urban workers, urban residents basic medical insurance fund expenditures, new rural cooperative medical insurance fund, per capita GDP, urbanization rate. A review of ＂ China Health Statistical Yearbook＂ from 2004 to 2014, statistics the data of total population at the end of the year, sex ratio, proportion of population aged 65 and above, the number of health institutions, medical and health institutions in the inpatient surgery visits, average hospitalization days, average medical income of each hospital, hospital inpatient medical expense per person. Using Pearson correlation analysis and multiple stepwise regression analysis to analyze the influencing factors of the per capita medical insurance fund expenditure. Results Multiple stepwise regression analysis showed that, the average of each public hospital medical income has effect on the medical insurance fund expenditure per person, the average of each public hospital medical income increases 100 yuan, the national of the medical insurance fund expenditure per person increases 6. 9 yuan, 99. 6% changes of the medical insurance fund expenditure per person can be explained by the average of each public hospital medical income. Pearson correlation analysis showed that, there were negative correlations between average medical income and sex ratio and average hospital inpatient days, but there were positive correlations with GDP perperson, proportion of population aged 65 and above, urbanization rate, the number of health institutions, hospital inpatient surgery visits , inpatient medical expenses per person （ P 〈 0. 05 ）. Conclusion Controlling public hospital ＂s medical income is the key to controlling the medical insurance fund expenditure. So,need to increase government financial aid, and reduce dependence on the hospital s medical income; Reform the existing health care settlement mode, strengthen the supervision and management of the medical insurance fund ; To strengthen the construction of primary - level medical institutions, the grading system was carried out; carrying out hierarchical diagnosis and treatment system, implementing measures of primary - level medical institutions treat not ill.