城乡医保整合对参保者在某三甲医院住院费用的影响

The effect of urban and rural medical insurance integration on the hospitalization expenses of the insured in a third grade hospital

目的:通过比较某市城乡居民医保整合前后参保者在某三甲医院住院费用,分析其现状和影响因素。方法:选择2015年7月-2018年6月连续三年某市参保者在该三甲医院住院病例资料,比较医保整合前后,该市参保者人均住院费用、人均统筹及药占比等。结果:城乡居民医保整合后,该市参保者在该院人均统筹15117.87元高于城乡医保整合前的9898.35元和10541.54元;实际补偿比67.35%高于整合前53.29%和54.53%;药占比31%低于整合前的35.02%和35.77%。结论:城乡居民医保整合后,参保者尤其是原新农合参保者的待遇水平显著提高,患者住院负担明显降低,应加快安徽省城乡居民医保整合的步伐。

Objective:By comparing the hospitalization expenses of the insured in a grade iii hospital before and after the medical insurance integration of urban and rural residents in luan city, the current situation and influencing factors are analyzed. Methods:The data of hospitalized cases of insured persons in the third first-class hospital in luan city for three consecutive years from July 2015 to June 2018 were selected. Before and after the medical insurance integration, the per capita hospitalization expenses, per capita coordination and drug proportion of insured persons in the city were compared. Results:After the integration of medical insurance for urban and rural residents, the average per capita balance of the city enrollees in the hospital was 15117.87 yuan higher than that of 9898.35 yuan and 10541.54 yuan before the integration of medical insurance for urban and rural residents. The actual compensation ratio of 67.35% was higher than that of 53.29% and 54.53% before the integration. The proportion of medicine was lower than that of 35.02% and 35.77% before the integration.Conclusion:After the integration of medical insurance for urban and rural residents, the treatment level of the insured, especially the former new rural cooperative medical insurance, has been significantly improved, the burden of hospitalization of patients has been significantly reduced, and the pace of the integration of medical insurance for urban and rural residents in Anhui province has been accelerated.