混合式支付方式对住院费用影响的探讨

Discussion on the Effects of Mixed Payments on Inpatient Costs

目的:通过研究子宫肌瘤及慢性支气管炎患者住院费用的变化情况以及不同支付方式对于住院费用控制的效果,分析混合式支付方式对住院费用的影响。方法:对A市B医院2011—2015年522例子宫肌瘤患者及1102例慢性支气管炎患者的病案首页、一日清单以及新型农村合作医疗患者就诊明细数据进行统计学描述与分析。结果:子宫肌瘤患者住院次均费用变化波动,慢性支气管炎患者的住院次均费用变化趋势平稳。不同支付方式患者人次结构随支付标准的变化而变化。结论:由于对按项目付费的准入和不同支付方式之间的选择及转换监管力度不够,供方趋于将患者推向支付标准更高的支付方式,缺乏精算管理和有效监管的混合式支付方式对住院费用控制效果不明显。

Objective： To analyze the effects of mixed payment methods on hospitalization cost of patients by studying the changes in hospitalization cost of patients with uterine fibroids and acute exacerbation of chronic bronchitis respectively. Methods： Statistical description and data analysis were conducted on the data of their medical record front sheet and one-day cost report and detailed medical treatment data form new rural cooperative medical institutions of 522 cases of uterine leiomyoma patients and 1 102 cases of chronic bronchitis patients to perform the statistical analysis. Results： The variety of uterine fibroids average hospitalization cost was fluctuating, and the variety of chronic bronchitis was steady. The proportion of people discharged of different payments varied along with variety of payment criteria. Conclusion： The effect of mixed payment on hospitalization cost was not obvious due to inadequate supervision of entry to the fee-for-services and selection and conversion between different payment methods. Medical service provider tended to push patients to apply the payment method with higher standards.