基于医保公平视野下不同级别公立医院老年骨质疏松性骨折住院费用对比分析

Comparative analysis of hospitalization expenses of the elderly with osteoporotic fracture in different levels of public hospitals based on the perspective of health insurance equity

[目的]了解山西省公立医院老年骨质疏松性骨折患者的住院费用及不同医保类型住院费用的差别,为完善医保政策和合理控制医疗费用提供建议。[方法]选取山西省12个市区内10所三级医院和10所二级医院中符合调查要求的582例患者,由患者所在医院的骨科专职护士填写《患者出院结算费用明细表》,并运用秩和检验对其住院费用进行分析。[结果]二级医院与三级医院的总费用、手术费、检查费、化验费、护理费、医药费差异均有统计学意义(P<0.05);同一级别医院中不同医保类型患者统筹支付费用之间差异均无统计学意义(P>0.05);在三级医院中,城乡居民基本医疗保险患者的平均住院费用及自付费用、城镇职工基本医疗保险患者的自费费用均高于二级医院,差异有统计学意义(P<0.05)。[结论]我国医保政策整体效能良好,但仍需持续关注重点管控对象。

Objective To understand the hospitalization expenses of the elderly with osteoporotic fracture in public hospitals of Shanxi Province and the difference of hospitalization expenses among different types of medical insurance,and to provide suggestions for perfecting the medical insurance policy and reasonably controlling medical expenses.Methods A total of 582 patients from ten tertiary hospitals and ten secondary hospitals in 12 districts of Shanxi Province were selected and their hospitalization costs were analyzed by rank sum test.The orthopedic full-time nurse filled in the Patient Discharge Settlement Fee Schedule.Results There were statistically significant differences in total cost,operation cost,check-up cost,laboratory cost,nursing cost and medical cost of secondary hospitals and tertiary hospitals(P<0.05).There was no statistically significant difference in the overall payment of patients with different types of medical insurance in the same level of hospitals(P>0.05).In tertiary hospitals,the average hospitalization expenses and out-of-pocket expenses of patients with basic medical insurance for urban and rural residents,and out-of-pocket expenses of patients with basic medical insurance for urban workers were higher than that of secondary hospitals,and the difference was statistically significant(P<0.05).Conclusions The overall efficiency of China s medical insurance policy is good,but it still needs to pay continuous attention to the key control objects.