吉林省儿童患者就医医保待遇分析

The analysis of medical insurance benefit of children patients in Jilin Province

目的客观地了解吉林省儿童患者的就医医保待遇,找出其中可改进的地方,提出改进的建议和对策。方法选取2017-2019年儿童患者的住院信息,主要包括住院人次、住院费用、出院诊断及医保性质等内容,采用描述性分析的方法进行分析、比较。结果儿童患者的住院人次在逐年增长,次均住院费用几乎呈现出逐年平稳上升的趋势;儿童患者的疾病谱相对比较稳定;因意外伤害而住院的儿童人次在逐年增加;长春市内、外的儿童医保患者次均住院费用及次均报销比例均呈现逐年上升的趋势。而每一年度内,长春市内儿童医保患者的次均住院费用均要低于长春市外的儿童医保患者,而次均报销比例要远高于长春市外的儿童医保患者;三级医院的报销比例,2020年相较于2019年相比是降低的,二级和一级及以下医疗机构报销比例则是升高的等等。结论应适当提高异地儿童医保的报销比例;合理的设置长春市各个级别医院的报销比例;促进儿童商业医疗保险的发展,建立多层次的儿童医疗保障体系;提高全社会对儿童因意外伤害而住院的重视程度;提高儿童罕见病的报销待遇。

Objective Through understanding medical insurance benefit of children patients in Jilin Province,finding out what can be improved,we put forward suggestions and countermeasures for improvement.Methods We collect the information about children patients of a Third-Class hospital in Changchun from 2017 to 2019,mainly including the number of children patients,hospitalization expenses,discharge diagnosis,types of medical insurance etc.Descriptive analysis was used to compare the results.Results The number of children patients went up,average hospitalization expenses has almost a steady rise year by year;the disease spectrum of children is relatively stable;the number of children patients hospitalized for accidental injuries went up year by year;Average hospitalization expenses and the reimbursement ratio of children patients has a rise year by year inside and outside Changchun.In evey year,average hospitalization expenses of children patients in Changchun was lower than that out of Changchun,but the reimbursement ratio of children patients in Changchun was far higher than that out of Changchun.The reimbursement ratio of children patients in 2020 is lower than that in 2019 in Third-Class hospitals,the reimbursement ratio of children patients in 2020 is higher than that in 2019 in Second-Class and First-Class hospitals.Conclusion We should appropriately increase the reimbursement ratio of children’s medical insurance in other places;set up reasonably reimbursement proportion of hospitals at all levels in Changchun;promote the development of commercial medical insurance for children,establish a multilevel medical security system for children;improve the whole society’s attention to the hospitalization of children due to accidental injuries;increase the reimbursement ratio of medical insurance about children rare diseases.