医保费用总额预付制支付方式的实施效果实证分析

Analysis on the Implementation Effect of Medical Insurance Expenditure Prepayment System

目的:对比分析哈尔滨市在全面实施医保费用年度总额预付制支付方式前后的相关指标变化,评价总额预付制支付方式的实施效果,对医保支付政策的更好实施提出合理化建议。方法:运用SPSS软件进行数据汇总统计,描述性分析比较市医保在医保总额预付制实施前后医保住院患者相关指标的情况。结果:该市在医保总额预付制实施两年后,医保住院患者量,患者的住院次均费用等指标均有明显变化。整体市医保次均住院费用及医保次均支付费用呈负增长。结论:实施医保总额预付制后,患者的次均费用的控制效果显著,但也暴露出了一些问题,需要在政策及方式和方法上有相应的调整,以便适应国家医疗改革的深入开展,缓解人民群众"看病难、看病贵"的现状。

Objective： To compare and analyze the changes ot-the full implementation of relevant indicators before and after imple-menting the medical insurance payment in the total prepaid amount in Harbin, evaluate the implementation effects of total prepayment method and propose the reasonable suggestion on better implemenlation of medical insurance policy. Methods： Using SPSS Software for data collection and conduct descriptive analysis so as to compare the related indicators of hospitalization patients under municipal medical insurance before and after the implementation of medical insurance prepayment system. Results： 2 years after tile implemen-tation, there were significant changes in the amount of medical insurance, the amount of inpatient care. and the average hospitalization expenses of patients. The overall municipal medical insurance and the average hospitalization expenses were on negative growing. Conclusion： After tire implementation of the total amount of prepayment medical system, the control effect with the average cost was significantly, but it also exposed some problems. It needed to have some appropriate adjustments in tbe policy so as to adapt to the national health care reform in depth and to alleviate the cur-rent situation of ＂difficult and expensive to get medical service＂ .