三明市公立医院改革前后医保控费效果分析

Analysis on the Cost Control Effects of Medical Insurance before and after the Reform of Public Hospitals of Sanming

目的:分析三明市22家公立医院改革前后医保病人门诊、住院医疗费用变化情况。方法:2014年7月对三明市公立医院改革实施情况进行了实地调研,了解到2011—2013年医保病人门诊和住院费用的相关数据,录入Excel表格,进行纵向描述性分析。结果:城乡居民住院和城镇职工门诊次均统筹基金逐年增加、城镇职工医保住院次均费用下降明显、改革后的2012年及2013年三项指标均低于福建省和全国同期水平。结论:改革控费效果显著,对城乡居民次均住院费用和门诊费用管理方面还有待于进一步探索和加大改革力度。

Objective:To analyze the changing situation of outpatient and hospitalization expenses for patients under medical insurance in 22 public hospitals of Sanming before and after the refom.Methods:Field survey was performed on the reform implementation situation of public hospitals of Sanming in July of 2014. The relevant data of outpatient and hospitalization expenses for patients under medical insurance from 2011 to 2013 was recognized and put into Excel spreadsheets. Vertical descriptive analysis was performed.Results:The average pooling fund of urban and rural resident hospitalization and urban employee outpatient increased by years. The average expense for urban employee medical insurance decreased obviously. Three indicators of 2012 and 2013 after reform were lower than Fujian and national level.Conclusion:Reform of the control effect was remarkable. Further exploration and intensified reform were still needed for the management of average hospitalization expense and hospitalization expense for urban and rural resident.