城乡居民大病保险对居民医疗费用负担的影响研究

Analysis of the Impact of Urban and Rural Residents' Serious Illness Insurance on Residents' Medical Expense Burden

目的分析城乡居民大病保险对居民医疗费用负担的影响。方法分析2014年江苏省某市中医医院新农合参保病人住院费用的抽样调查数据。结果400名大病住院病人的住院时间为10.91±8.41d,总费用为7 864.34±9 582.53元,补偿额为3 530.48±3 797.74元,自付费用为4 333.86±5 992.21元,自付比例0.55%±0.09%,药品费用2 402.59±2 463.10元。住院天数增加以及药品费用的上升可导致医疗费用增加。若未参保新农合,则有110名患者承担的医疗费用>7 708元,灾难性支出发生率为27.5%;在参保补偿后,有40名患者自付的医疗费用在7 708元以上,灾难性支出发生率为10.0%。若以3 083元为标准,有183名患者自付的医疗费用在3 083元以上,灾难性支出发生率为45.8%。结论该市的报销比例略低于50%,住院天数增加以及药品费用的上升可导致医疗费用增加。

Objectives To analyze the impact of urban and rural residents＇ serious illness insurance on residents＇ medical expenses.Methods The hospitalization expenses of the new rural cooperative medical insurance patients in the hospital of traditional Chinese medicine in a city in 2014 were analyzed.Results The hospitalization time of the400 hospitalized patients was 10.91 ± 81 d,the total cost was 7 864.34±9 582.53 yuan,the compensation amount was 3 530.48±3 797.74 yuan,the self-pay was 4 333.86 ± 952.21 yuan,the ratio of self-pay was 0.55±0.09%,the drug cost was 2 402.59 ± 2 463.10 yuan.Increased hospital stay and increased drug costs could lead to increased medical costs.The 110 patients（27.5%）uninsured in new rural cooperative medical care had to bear more than 7 708 yuan medical expenses.When they insured in the new rural cooperative compensation,40 patients（10.0%）pay more than 7 708 yuan.If the standard was 3 083 yuan,183 patients（5.8%）had to pay more than 3083 yuan for medical expenses.Conclusions The reimbursement proportion in the city is slightly lower than 50%.The increase of hospital days and drug cost can lead to the increase of medical expenses.