城镇职工基本医疗保险省外异地就医问题研究——以太原市为例

Study on the Medical Treatment of Urban Workers’ Basic Medical Insurance in Different Places outside the Province——Taking Taiyuan City as an Example

目的通过分析山西省太原市城镇职工省外异地转诊的人次、病种、就医流向及费用情况,从而了解当前太原市异地就医的现状和特点,为提升山西省区域范围内医疗服务水平、居民异地就医的便捷性和经济性,提供政策依据。方法对太原市城镇职工省外异地转诊的人次、病种、就医流向和费用等数据进行回顾性分析和描述性统计分析。结果从职工省外就医的类型、年龄、病种、流向来看,患者以在职职工为主,年龄多在41岁以上,以肿瘤疾病为主,流向主要集中在北京;从发生的费用来看,在职职工和退休职工的实际报销比例均低于本地就医人群。结论区域医疗卫生水平提升需要一个过程,省外异地就医现象将长期存在,可从提升区域医疗卫生水平、提高省外异地就医管理服务两方面入手缓解异地就医难的问题。

Objective To analyze the current situation and characteristics of current medical treatment in Taiyuan City by analyzing the number of people,diseases,medical treatments and expenses of urban workers in Taiyuan City,in order to improve the medical services in Shanxi Province.Provide a policy basis for the convenience and economy of the hospitals and residents in different places.Methods Retrospective analysis and descriptive statistical analysis were carried out on the data of the number of people,diseases,medical treatments and expenses of urban workers in Taiyuan.Results From the perspective of the type,age,disease type and flow of medical treatment outside the province,the patients were mainly active employees,and the age was over 41 years old.The main focus was on cancer diseases,and the flow was mainly concentrated in Beijing.The actual reimbursement ratio of active employees and retired employees is lower than that of local medical practitioners.Conclusion The improvement of regional medical and health level requires a process.The phenomenon of medical treatment outside the province will exist for a long time.It can raise the problem of medical treatment in different places from the aspects of improving regional medical and health level and improving medical management services outside the province.