2014—2015年东莞市寮步镇医保住院费用支出情况分析

Analysis on hospitalization cost of inhabitants in Liaobu town,Dongguan city from 2014 to 2015

目的分析2014—2015年东莞市寮步镇医保住院费用支出情况,为完善分级诊疗制度提供依据。方法采用回顾性研究方法,分析该镇参保人员住院治疗时的就医地选择、住院医疗费用总额及自付比例等情况。结果研究期限内,该镇参保人员共发生医保结算31 443次,其中8 663次(27. 55%)为本镇医院,21 880次(69. 59%)为镇外市内医院,900次(2. 86%)为市外医院。根据就医地将患者分为本镇医院组,镇外市内医院组和市外医院组进行分析,结果显示,市外医院组的住院医疗费用总额中位数和平均自付比例高于镇外市内医院组和本镇医院组; 3组患者的住院天数中位数相差不大。结论近年来,东莞市寮步镇医保住院费用支出情况基本符合分级诊疗及相关管理制度的政策预期,为合理使用医疗卫生资源和医保基金,减轻患者疾病负担,应进一步完善分级诊疗体系。

Objective To analyze the hospitalization cost of inhabits in Liaobu town from 2014 to 2015,and provide a basis for improving the graded diagnosis and treatment policy.Methods A retrospective study was conducted to analyze the choice of hospitals,average hospitalization cost and self-payment ratio.Results There were 31,443 medical insurance accounts in total,of which 8 663(27.55%)were in local town hospitals,21,880(69.59%)were local city hospitals,and 900(2.86%)were hospitals in other cities.According to the hospital location,inpatients were divided into the group in the town,the group in the city,and the group in other cities for further analysis.The median hospitalization cost and average self-payment ratio of the group in other cities were obviously higher than those of the other two groups.The median length of stay of the three groups were similar.Conclusion In recent years,the expenditure of medical insurance hospitalization expenses in Liaobu town,Dongguan city was basically in line with the policy expectations of graded diagnosis and treatment systems,and we should further strengthen the policy to control the medical cost and reduce the burden of inpatients.