上海某三甲医院医保患者医疗费用分析

摘要

目的 探讨医保总额预付制的实施对上海市某三甲综合性医院各类医保患者医疗费用的影响.方法 对2011年至2015年该院成人和少儿患者医疗费用相关指标变化进行统计分析,比较该院总额预付制实施以来各类医保患者医疗费用相关指标总体变化趋势.结果 实施总额预付制后,该院医疗业务量持续增长,而城保患者门急诊次均费用增长幅度(12.5％)低于自费患者(19.4％),住院人均费用增长幅度(16.9％)低于自费患者(28.1％);城保患者住院人均药费增长幅度(9.7％)低于自费患者(20.5％),住院人均材料费用增长幅度(37.6％)也低于自费患者(63.6％).结论 总额预付制实施后,该院城保患者医疗费用控制取得良好效果,但少儿医保患者和自费患者等未纳入总额预付制的各类患者医疗费用增长幅度仍较大.%Objective To analyze the medical expense indexes of health insurance for adults and children in a tertiary comprehensive hospital in Shanghai from 2011 to 2015,and to evaluate the influence of global budget on medical expenses.Methods This thesis conducted a statistic analysis on changes of medical expenses for adults and juvenile patients,after the implementation of the global budget.Results After the implementation of the global budget,number of medical services continues to grow in this hospital,the growth rate about outpatients and emergency per capita costs and average hospitalization expenses of patients with urban employee's basic medical insurance was lower than self-paid patients (the growth of outpatients and emergency per capita costs:12.5％ vs.19.4％,the growth of average hospitalization expenses:16.9％ vs.28.1％),the growth rate of inpatients' per capita drug costs and per capita consumables costs was lower than self-paid patients (the growth of inpatients' per capita drug costs:9.7％ vs.20.5％,the growth of inpatients' per capita consumables costs:37.6％ vs.63.6％).Conclusion The global budget is effective in controlling medical expenses,but the growth of medical expenses of juvenile patients and self-paid patients is still high.