某肿瘤医院门诊慢特病费用跨省直接结算运行情况初探

Preliminary study on inter-provincial direct settlement of outpatient expenses for patients with chronic diseases and special diseases in a cancer hospital

目的分析北京市某肿瘤医院异地门诊慢特病患者的跨省直接结算运行数据,探讨政策实施效果并提出相应建议。方法采用描述性分析法,对北京某三级甲等肿瘤医院2022年异地门诊慢特病患者的实时结算数据进行统计分析,包括就医例次变化趋势、就医人群年龄结构分布、就医人群病种分布、就诊科室、费用结构及医保待遇支付情况等。结果2022年该院共收治来自28个省份和新疆生产建设兵团的异地门诊慢特病患者12812例次,由1月的53例次增至12月的1957例次;患者年龄11~88岁,以51~70岁患者居多;主要病种为肺恶性肿瘤;主要就诊科室为内科(进行化学治疗)和放疗科(进行放射治疗);诊疗费占比较高;平均医保基金支付占比为79.94%。结论异地门诊慢特病直接结算政策进一步释放异地门诊就医需求,极大减轻肿瘤患者的经济负担,有助于解决肿瘤等重大疾病患者"看病难、看病贵"的问题。

Objective To analyze the operation data of inter-provincial direct settlement of patients with chronic diseases and special diseases in outpatient service,explore the effect of policy implementation and put forward corresponding suggestions.Methods The descriptive analysis method was used to analyze the real-time settlement data of outpatients with chronic disease and special disease of a grade A tertiary cancer hospital in Beijing in 2022,including changing trend in medical visits,age distribution of the medical population,disease distribution of the medical population,medical departments,cost structure,and payment of medical insurance benefits.Results In 2022,the hospital admitted a total of 12812 outpatient patients with chronic and special diseases from 28 provinces and Xinjiang Production and Construction Corps,with an increase from 53 in January to 1957 in December.The age of the patients was 11 to 88 years old,most of whom were 51 to 70 years old.The main disease was lung cancer,and the main visiting departments were internal medicine(chemotherapy)and radiotherapy(radiotherapy).The cost of diagnosis and treatment was relatively high,and the average proportion of medical insurance fund payment was 79.94%.Conclusions The inter-provincial direct settlement policy for outpatients with chronic diseases and special diseases could further release the demand for medical treatment,greatly reduce the economic burden of cancer patients,and help to solve the problem of"difficult and expensive medical treatment"for patients with cancer and other major diseases.