长三角医保一体化视野下的医疗服务价格现状分析

Analysis on the current situation of medical service price from the perspective of medical insurance integration in the Yangtze River Delta

目的梳理我国长江三角洲(以下简称长三角)地区各省份医疗服务价格管理现状, 为长三角医保一体化工作提供参考。方法以长三角各省份发展和改革委员会、卫生健康委员会、医疗保障局等官方网站发布的医疗服务价格改革相关政策以及现行医疗服务价格项目规范为研究资料, 检索时间截至2020年12月。采用R 4.0.2软件对医疗服务价格项目进行描述性分析。结果近年来, 长三角各省份陆续推进了医疗服务价格改革, 但各省份现行的医疗服务价格项目规范并不统一。从项目数量来看, 江苏省的基础项目数量最多, 为4 457项, 浙江省最少, 为3 914项;浙江省的分解项目数量最多, 为1 988项, 是安徽省的17.6倍;从价格水平来看, 上海市的医疗服务价格平均值最高, 为1 041.6元, 江苏省最低, 为768.6元, 部分医疗服务项目在长三角各省份间的价格差异幅度超过20倍。结论长三角各省份的医疗服务价格项目设置和价格水平存在较大差异, 应当加快推进医疗服务价格项目规范的统一, 进一步优化医疗服务价格水平, 完善医疗服务价格比较体系, 以促进长三角医保一体化发展。

Objective To sort out the medical service price management in provinces of the Yangtze River Delta,and identify problems in the process of promoting the integration of medical insurance in the said region.Methods The service price reform policies and current medical service price items specifications as of December 2020 were collected from the official websites of the reform and developmet committees,health comissions and health insurane bureaus of these provinces.Descriptive analysis using R 4.0.2 software were conducted.Results Given the reform of medical service prices advanced in these provinces successively,the current medical service price items were not yet unified.In terms of the numbers,Jiangsu topped the rest by 4457 basic items,while Zhejiang ranked the lowest at 3914.In terms of decomposed items,Zhejiang topped the rest by 1988,17.6 times that of Anhui province.In terms of pricing level,the average price of medical services in Shanghai topped the rest by 1041.6 yuan,while Jiangsu province was the lowest at 768.6 yuan.The price of some items varied by more than 20 times among these provinces.Conclusions The provinces in the Yangtze River Delta had significant gaps in medical service price items setup and price levels.It is necessary to promote the regional coordinated specifications of medical service price items,further optimize the price levels,improve the methodological system of medical service price comparison,and promote the integration of medical insurance in the Yangtze River Delta.