儿童医院异地就医费用直接结算运行情况分析

Analysis on the Operation of Direct Settlement of Inter-provincial Medical Expenses in Children’s Hospitals

目的分析儿童医院跨省异地就医费用直接结算情况了解这一政策的知晓及满意度。方法以2017年8月至2018年12月上海市两家三级甲等儿科医院出院结算的所有“异地医保”患儿为研究对象,应用统计检验方法分析其疾病和住院费用情况。通过问卷调查了解异地就医人员对异地就医直接结算的知晓和满意度。结果“异地医保”患儿以血液等病情复杂的疾病为主,平均住院费用22311.54元,报销比例52.1%。异地就医直接结算政策知晓度为42.2%,政策满意度为93.7%,完成异地就医备案人员相对较少,主要原因是不知晓政策。结论儿童医院“异地医保”覆盖广,患儿病情复杂费用较高,报销比例较高一定程度减轻了经济负担,需加强医保政策宣传、规范异地转诊,确保满足合理异地就医需求。

Objective:To analyze the direct settlement of inter-provincial medical expenses in children’s hospitals and to understand the awareness and satisfaction with this policy.Method:All children with“out-of-town medical insurance”discharged from two pediatric hospitals of class A and grade three in Shanghai,from August 2017 to December 2018,were taken as the research objects,and their diseases and hospitalization expenses were analyzed by statistical test method.Through the questionnaire survey,the knowledge and satisfaction of the personnel who enjoyed the direct inter-provincial settlement for inter-provincial medical treatment were understood.Result:The children in the“out-of-town medical insurance”mainly suffered from complicated diseases such as blood,and the average hospitalization expense was 223,11.54 yuan,accounting for 52.1%of the reimbursement rate.The degree of awareness of the direct settlement policy for medical treatment in other places was 42.2%,and the degree of satisfaction with the policy was 93.7%.Relatively few people completed the record for medical treatment in other places,mainly because they did not know the policy.Conclusion:The“out-of-town medical insurance”in children’s hospitals covers a wide range of patients,and the high cost and reimbursement ratio reduce the economic burden to a certain extent.Therefore,it is necessary to strengthen the publicity of medical insurance policies and standardize out-of-town medical referral,so as to ensure that reasonable out-of-town medical treatment needs are met.