城镇居民中慢性病患者门诊统筹服务利用及费用分析——以广西壮族自治区肿瘤医院为例

Overall service utilization and cost analysis of outpatients with chronic diseases in urban residents-taking Guangxi District cancer hospital as an example

目的门诊统筹是医疗保险支付门诊医疗费用的一种形式，本课题通过调查门诊统筹下广西医科大学附属肿瘤医院（以下简称广西区肿瘤医院）的城镇居民慢性疾病的门诊服务利用及费用情况，对比分析门诊统筹与个人自付的门诊服务与医疗费用的发生情况，以及对门诊统筹比重情况的分析，探究门诊统筹对减轻慢性病患者就医情况和就医经济负担的影响和作用，为政府及医疗机构制定科学、有效、可行的建议。方法采用回顾性的调查研究方法，收集广西区肿瘤医院在2015年1—12月份慢性病患者的就诊人次和就诊费用。采用统计描述、相关性分析等方法分析门诊统筹下慢性病患者门诊服务利用和费用的发生情况。结果2015年广西区肿瘤医院城镇居民慢性病门诊统筹基金支付率达到57．69％，门诊次均费用较高但是相对平稳，次均费用与统筹基金支付比重有显著相关关系。结论门诊统筹医疗保险制度的实施在减轻慢性病患者及其家庭的经济压力方面起到了积极作用，门诊的卫生服务利用也处于较高水平，但是在门诊次均费用控制方面还有待加强。

Objective Outpatient service is a form of medical insurance payment of outpatient medical expenses, this paper investigated the outpatient service utilization and cost of chronic diseases of urban residents in District Cancer Hospital of Guangxi Province （Affiliated Tumor Hospital of Guangxi Medical University）, compared with outpatient clinic service and the individual pays medical expenses, and analysis of the proportion of outpatient co-ordination, explore outpatient co-ordination to reduce the impact of chronic disease patients and the medical burden and role, formulate scientific and effective and feasible suggestions for the government and medical institutions. Methods A retrospective investigation method was used to collect the visits and expenses of the patients with chronic diseases in the Guangxi cancer hospital in 2015. Statistical description, correlation analysis and other methods were used to analyze the outpatient service utilization and the cost of outpatient service. Results In 2015, the payment rate of tbe chronic disease outpatient Co-ordinating fund in Guangxi District Cancer Hospital reached 57.69%, while the outpatient expenses were higher but relatively stable. The average cost has a significant correlation with the proportion of the overall fund payment. Conclusion The implementation of outpatient integrated medical insurance system plays a positive role in reducing the economic pressure of patients with chronic diseases and their families. The utilization of outpatient health services is also at a high level, but the cost control of outpatient services needs to be strengthened.