上海市社会办医疗机构基本医疗保险医疗费用分析

Analysis on Medical Costs of the Patients Ensured Basic Social Health Insurance in Non-public Medical Institutions of Shanghai

目的:分析上海市社会办医疗机构基本医疗保险的医疗费用状况。方法:通过上海市医疗保险信息中心收集2016年上海市所有社会办医疗机构基本医疗保险医疗费用的数据。结果:2016年上海市一级和二级社会办医疗机构基本医疗保险的门诊平均人日医疗费用分别为293.56元(40.82~1 360.39元)和395.28元(113.42~1 606.53元),住院平均床日费用分别为1 360.05元(59.27~5 706.76元)和4 110.59元(254.11~8 160.27元);不同级别、不同类型和不同办医性质社会办医疗机构基本医疗保险的医疗费用及其构成不同。结论:上海市社会办医疗机构基本医疗保险的医疗费用及其构成差异大,应加强对社会办定点医疗机构基本医疗保险费用的监管。

Objective： To analyze medical costs of the patients with basic social health insurance（BSHI） in non-public medical institutions in Shanghai. Methods： The data related to medical costs of the patients with BSHI in all non-public medical institutions authorized by BSHI during 2016 were collected from the information center of Shanghai medical insurance. Results： In 2016, the average patient-day costs of the outpatients with BSHI in medical institutions at first level and second level were 293.56 yuan （40.82 ynan-1 360.39 yuan） and 395.28 yuan （113.42 yuan-1 606.53 yuan）, respectively. The average bed-day costs of the inpatients with BSHI were 1 360.05 yuan（59.27 yuan-5 706.76 yuan） and 4 110.59 yuan （254.11 yuan-8 160.27 yuan）, respectively. Medical costs and their compositions of the patients with BSH1 were different between different levels, between different ownerships and among different types of non-public medical institutions. Conclusion： The medical costs and their compositions of the patients with BSHI had significant differences among non-public medical institutions. BSHI should enhance its surveillance of medical cost in non-public medical institutions.