2015—2019年广西城乡居民医疗保险卫生服务利用与医保待遇水平分析

Analysis of the Utilization of Medical Insurance and Health Services and the Level of Medical Insurance Treatment of Urban and Rural Residents in Guangxi from 2015 to 2019

目的:对2015-2019年广西城乡居民医疗保险卫生服务利用与医保待遇水平进行分析,探索其存在的问题并提出相应建议。方法:从不同主体的普通门急诊、门诊大病、住院的次均就诊费用及平均住院日和相对应的统筹支付占比等指标来描述分析广西2015-2019年城乡居民医疗保险卫生服务利用和医保待遇水平情况;结果:普通门急诊、门诊大病和住院的次均费用的年均增长率变化区间分别为-3.49%~8.38%、2.93%~31.41%和-3.36%~10.42%;其中,总体门诊大病次均就诊费用、大学生、学生儿童、三级医院和异地就医门诊大病次均就诊费用年均增长率分别为9.39%、31.41%、13.39%、13.01%和23.7%;平均住院日年均降幅在4.5%-10.26%之间。总统筹支付占比在37.82%~59.44%之间。结论:门诊大病费用增长较快;平均住院床日有效缩短;保障待遇水平应加强费用控制,减少患者就医中的不合理开支。

Objective:To analyze the utilization of medical insurance and health services and medical insurance treatment levels of urban and rural residents in Guangxi from 2015 to 2019,explore the existing problems and make corresponding suggestions.Methods:The indicators of general outpatient emergency,outpatient critical illness and inpatient visits of different subjects,the average hospital stay and the corresponding proportion of overall payment and other indicators are applied to describe and analyze Guangxi’s2015—2019 urban and rural residents’medical insurance health service utilization and medical insurance treatment level.Results:The average annual growth rates of the average outpatient expenses for outpatient emergency department,outpatient major illness and hospitalization are-3.49%~8.38%,2.93%~31.41%and-3.36%~10.42%respectively.The average annual growth rates of the average visit cost per visit,college students,students and children,tertiary hospitals and outpatient clinics for major illnesses are 9.39%,31.41%,13.39%,13.01%and 23.7%respectively;the average hospitalization length ranges from 4.5%to 10.26%.The proportion of presidential payments ranges from 37.82%to 59.44%.Conclusion:The cost of outpatient major illnesses is growing faster;the average hospitalization length is effectively shortened;the level of guarantee treatment should strengthen the cost control and reduce the unreasonable expenses of patients in seeking medical treatment.