城镇职工心力衰竭患者卫生服务利用和直接医疗费用现状分析

Analysis on the status of health service utilization and direct medical expenses in urban employees with heart failure

[目的]了解城镇职工基本医疗保险心力衰竭患者门诊费用和住院费用现状,为减轻患者经济负担和保证医保基金可持续发展提供参考。[方法]利用浙江省城镇职工基本医疗保险心力衰竭患者2013-2017年个体报销面板数据,对患者卫生服务利用和年总费用、年门诊费用、年住院费用以及年住院费用占比现状进行描述和分析。[结果]共纳入浙江省城镇职工基本医疗保险心力衰竭患者8155名,其中老年人(60岁及以上)占比69.0%,男性4776名(58.6%);2017年年门诊次数中位数为25次,年住院1次的患者占比为50.9%,年总费用中位数为8820元,年住院费用中位数为17887元,年门诊费用中位数为6310元,年住院费用占比59.4%;心力衰竭患者5年门诊费用与5年住院费用中位数相当;首次确诊为心力衰竭的患者,当年年总费用较上年增长一倍。[结论]心衰的确诊会显著增加患者直接医疗费用,心力衰竭患者面临较重的直接医疗费用。

Objective To know the status of outpatient and hospitalization expenses of patients with heart failure under basic medical insurance for urban employees so as to provide reference for the reduction of patients economic burden and the sustainable development of medical insurance funds.Methods It used the panel data of individual reimbursements of urban employees with heart failure under basic medical insurance in Zhejiang Province from 2013 to 2017.It described and analyzed the ratio of patients health service utilization,annual total expenses,annual outpatient expenses,annual hospitalization expenses.Results 8155 patients with heart failure under basic medical insurance for urban employees in Zhejiang Province were included,among whom 69.0%were elderly(60 years old and above),4776(58.6%)were males and 3379(41.4%)were females.In 2017,the median number of annual outpatient visits was 25 times,and the proportion of patients hospitalized once a year was 50.9%,the median number of annual total expenses was 8820 yuan,the median number of annual hospitalization expenses was 17887 yuan.The median number of annual outpatient expenses was 6310 yuan.The proportion of annual hospitalization expenses was 59.4%.The median number of 5-year outpatient expenses was comparable to 5-year hospitalization expenses for the patients with heart failure.For patients with heart failure at the first time,the total cost doubled in that year compared with last year.Conclusions The diagnosis of heart failure will significantly increase the direct medical expenses of patients.Patients with heart failure face heavier direct medical expenses.