单病种患者住院及补偿状况分析——以陕西省某县为例

Analysis of hospitalization and medicare payments of monopathy patients-A case study of a county in Shaanxi province

目的对陕西省某县单病种与非单病种患者住院情况和补偿情况进行对比,以研究单病种支付方式的效果同时针对单病种支付中存在的问题提出政策建议,为支付方式的完善提供依据。方法以陕西省某县2007—2012年参与新农合医保人群为研究对象,按其是否单病种付费进行分组,分析单病种与非单病种参合患者的住院人次、住院费用、住院明细及补偿费用情况。运用SPSS 21.0统计学软件,采用Mann-Whitney U检验进行分析。结果 (1)2007—2012年单病种的次均住院费用低于非单病种,2011年两者之间差距达到最大,单病种住院费用为1 323元,非单病种为3 467元。(2)住院天数方面,单病种一般少于7 d,非单病种一般高于9.3 d。(3)2007—2009年单病种患者占比高于12%,但2010年占比减少到了8.89%,2011与2012年进一步缩减到约5%。(4)2011年开始单病种实际补偿比(50.45%)低于非单病种(67.82%)。结论 (1)从次均住院费用和住院天数方面看,当地新农合单病种支付方式效果明显。(2)单病种患者占比的减少提示,当地单病种支付模式还存在需要完善的地方,建议逐步扩大单病种覆盖面,实施疾病诊断相关分类(DRGs)。(3)单病种补偿比例逐渐高于非单病种,不利于单病种模式的推广,当地需要重视提高单病种实际补偿比,并探索推进支付方式改革。

Objective To study the effect of monopathy paymenf through comparing the hospitalization and medicare pay- ments of monopathy and non- monopathy in Shaanxi province, put forward policy recommendations targeting the existing problems in single disease payment, and provide a basis for the improvement of payment methods in China. Methods The participants in Shaanxi Province between 2007 and 2012 were enrolled into this study and assigned into monopathy group and non- monopathy group according to the monopathy payment （whether or not single disease）. The number of in- patients, hospitalization expenses, hospital details and compensation costs were compared between the two groups. The Mann-Whitney U test was performed by SPSS statistical software. Results ①Between 2007 and 2012, the average hos- pitalization cost of monopathy was lower than that of non- monopathy, especially in 2011, the hospitalization cost of monopathy was 1 323 yuan, and non- monopathy was 3 467 yuan. ②The hospital days of monopathy was generally less than 7 days, however, non- monopathy was usually higher than 9.3 days. ③ Between 2007 and 2009, the ratio of monopathy patients accounted for more than 12%, but the proportion decreased to 8.89% in 2010, and further to 5% in 2011 and 2012. ④From the year 2011, the actual compensation ratio （50.45%） for monopathy was lower than that for non- monopathy （67.82%）. Conclusion ①From the average hospitalization costs and hospital days, the effect of local NCMS single disease payment method is obvious. ②The reduction in the proportion of single disease patients prompted that the local monopathy payment model still needs some improvement. It is recommended to gradually expand the cover- age of monopathy, the implementation of disease diagnosis related classification （DRGs）. ③The proportion of monopathy payment that is higher than non- monopathy is not conducive to the promotion of single disease model. It is recommended that the local need to pay more attentions to the improvement of the actual compensation ratio of single disease, and explore the promotion of payment reform.