广州市某三甲医院两种医保支付方式住院费用比较与控费探讨

摘要

Objective:Through a comparative analysis of operation situation of hospitalization expenses between average cost quota payment method and payment by service project method from a level three grade A hospital in Guangzhou City , to explore the countermeasure of medical insurance costs control.Methods:Based on literature research method, the hospitalization expenses ma-terial of the sample hospital was calculated and comparative analyzed .Results:The numbers of inpatients who used average cost quota payment method and payment by service project method were both increasing year by year , while the payment by service pro-ject method was faster.The average expense of payment by service project method was apparently higher than average cost quota payment method.The average length of stay and proportion of material costs of payment by service project method were both higher than that of average cost quota payment method .Drug costs and material costs took the main proportion in the two medical insurance payment methods.The proportion of drug costs and average hospital stay decreased year by year while materials costs increased year by year.Conclusion:Off-site health insurance immediately released the patient's medical needs, but brought the expansion of med-ical expenses.The government should increase the health input of the second and third-tier cities to improve the level of medical services.Health insurance departments should speed up the reform of health insurance payments , strengthen supervision and man-agement by intelligent auditing system.The hospital should take the initiative to enhance the connotation construction and strengthen health insurance costs control management.%目的:通过分析广州市某三甲医院按平均费用定额支付与按服务项目支付两类患者住院费用运行情况,探讨医疗保险控费对策.方法:结合文献资料研究法,对住院患者费用明细资料进行数据统计、比较分析.结果:按平均费用定额支付与按服务项目支付住院患者业务量逐年上升且按服务项目支付增长更快;按服务项目支付次均费用明显高于按平均费用定额支付住院患者;按服务项目支付平均住院日、材料费占比均高于按平均费用定额支付;药品费、材料费在两种医保支付方式中均为主要占比,药费比、平均住院日逐年下降,而材料费不降反升.结论:异地医保即时结算释放了患者就医需求,也带来了医疗费用的膨胀.政府应加大对二三线城市卫生投入,提高医疗服务水平;经办部门应加快医保支付方式改革,运用智能审核系统强化监督管理;院方应主动提升内涵建设,加强医保控费管理.