本文關(guān)鍵詞： 乙型肝炎 直接醫(yī)療費(fèi)用 醫(yī)療保險(xiǎn) 門(mén)診 政策　出處：《東南大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的分析乙肝患者的直接醫(yī)療費(fèi)用及其構(gòu)成、影響因素,探討乙肝患者醫(yī)療保險(xiǎn)門(mén)診政策的實(shí)施現(xiàn)狀及存在的主要問(wèn)題,提出減輕乙肝患者經(jīng)濟(jì)負(fù)擔(dān)的合理措施,為完善醫(yī)療保險(xiǎn)政策提供依據(jù)。方法通過(guò)圖書(shū)館、互聯(lián)網(wǎng)、政府平臺(tái)等搜集江蘇省部分地區(qū)醫(yī)保門(mén)診政策的相關(guān)文件和管理辦法,并進(jìn)行歸納和整理。描述江蘇省13個(gè)統(tǒng)籌地區(qū)職工醫(yī)保、居民醫(yī)保和新農(nóng)合的醫(yī)保門(mén)診政策現(xiàn)狀,包括醫(yī)保門(mén)診病種設(shè)置、乙肝患者的保障情況以及政策的具體實(shí)施情況(待遇水平、支付方式等)。對(duì)江蘇省2所三級(jí)醫(yī)院感染科的乙肝就診患者50人和3所三級(jí)醫(yī)院感染科的臨床醫(yī)生5人進(jìn)行訪談,了解乙肝患者年人均門(mén)診就診次數(shù)以及醫(yī)生對(duì)《乙肝防治指南》的解讀和應(yīng)用情況。選取江蘇省2所三級(jí)醫(yī)院2014年1～12月14910人次門(mén)診乙肝患者和966人次住院乙肝患者作為實(shí)證研究樣本,從醫(yī)院病例病案系統(tǒng)獲取患者的直接醫(yī)療費(fèi)用及就診信息。描述門(mén)診和住院乙肝患者的直接醫(yī)療費(fèi)用及其構(gòu)成、次均直接醫(yī)療費(fèi)用、年門(mén)診費(fèi)用、醫(yī)保報(bào)銷費(fèi)用和報(bào)銷比例等;對(duì)乙肝患者的直接醫(yī)療費(fèi)用、住院天數(shù)進(jìn)行單因素分析;對(duì)住院乙肝患者直接醫(yī)療費(fèi)用進(jìn)行多元線性回歸分析。結(jié)果1.乙肝患者直接醫(yī)療費(fèi)用(1)門(mén)診乙肝患者在14910人次門(mén)診乙肝病例中,男性8952人次(60.04%),女性5958人次(39.96%);25～34歲年齡組就診人次最多(4131人次),占27.71%,0～14歲年齡組最少(56人次),占0.38%;醫(yī)�；颊�9940人次(66.67%),繳費(fèi)患者4970人次(33.33%);在醫(yī)�；颊咧�,職工醫(yī)�；颊�9830人次(98.89%),居民醫(yī)保患者110人次(1.11%);患者抗病毒治療率為37.46%,職工醫(yī)�；颊呖共《局委熉�(37.80%)高于居民醫(yī)保患者(29.09%)。14910人次門(mén)診乙肝病例直接醫(yī)療費(fèi)用總額為14188409.81元。次均門(mén)診費(fèi)用為951.60元,其中藥品費(fèi)比重最高(790.27元),占83.05%;年人均門(mén)診就診次數(shù)為12次,年人均門(mén)診費(fèi)用為11419.20元;次均門(mén)診費(fèi)用男性(997.71元)高于女性(882.32元),差異有統(tǒng)計(jì)學(xué)意義(P0.05);30～59歲年齡組(980.33元)最高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);職工醫(yī)�；颊�(953.22元)高于居民醫(yī)保患者(811.05元),差異有統(tǒng)計(jì)學(xué)意義(P0.05);抗病毒治療患者(1094.77元)高于未抗病毒治療患者(865.86元),差異有統(tǒng)計(jì)學(xué)意義(P0.05);患者次均報(bào)銷比例為62.32%,職工醫(yī)�；颊�(62.51%)高于居民醫(yī)保患者(42.76%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)住院乙肝患者在966人次住院乙肝病例中,男性649人次(67.18%),女性317人次(32.82%);25～34歲年齡組住院患者最多(339人次),占35.09%,0～14歲年齡組最少(11人次),占1.14%;醫(yī)�；颊�554人次(57.35%),繳費(fèi)患者412人次(42.65%)。在醫(yī)保患者中,職工醫(yī)�；颊�526人次(94.95%),居民醫(yī)�；颊�28人次(5.05%);患者抗病毒治療率為38.61%,職工醫(yī)保患者抗病毒治療率(39.35%)高于居民醫(yī)�；颊�(32.14%);住院天數(shù)平均24.78±16.81天,最多為15～29天住院天數(shù)組(416人次),占43.06%,最少為≥60天住院天數(shù)組(51人次),占5.28%;住院天數(shù)(中位數(shù))男性(21天)多于女性(19天),差異有統(tǒng)計(jì)學(xué)意義(P0.05);醫(yī)保患者(24天)多于繳費(fèi)患者(17天),差異有統(tǒng)計(jì)學(xué)意義(P0.05);職工醫(yī)�；颊�(24天)多于居民醫(yī)保患者(22.5天),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。966人次住院乙肝病例直接醫(yī)療費(fèi)用總額為12714108.85元。次均住院費(fèi)用13161.60元,其中藥品費(fèi)比重最高(9025.09元),占68.57%;次均住院費(fèi)用男性(13711.37元)高于女性(12036.05元),差異有統(tǒng)計(jì)學(xué)意義(P0.05);30天及以上住院天數(shù)組(18255.02元)高于其他住院天數(shù)組,不同住院天數(shù)組間費(fèi)用差異有統(tǒng)計(jì)學(xué)意義(P0.05);醫(yī)�；颊�(14153.12元)高于繳費(fèi)患者(11828.35元),差異有統(tǒng)計(jì)學(xué)意義(P0.05);重度乙肝患者(17256.20元)最高,中度乙肝患者(12827.62元)次之,輕度乙肝患者(11628.48元)最低,不同疾病嚴(yán)重程度組間費(fèi)用差異有統(tǒng)計(jì)學(xué)意義(P0.05);抗病毒治療患者(13957.82元)高于未抗病毒治療患者(12660.78元);患者次均報(bào)銷比例為70.45%,職工醫(yī)保患者(70.88%)高于居民醫(yī)�；颊�(60.95%),差異有統(tǒng)計(jì)學(xué)意義(P0.05);多元逐步回歸分析顯示,住院天數(shù)、疾病嚴(yán)重程度、抗病毒治療、結(jié)算方式是住院費(fèi)用的影響因素(P0.05)。2.醫(yī)保門(mén)診政策現(xiàn)狀及乙肝患者保障情況江蘇省各統(tǒng)籌地區(qū)的醫(yī)保門(mén)診政策項(xiàng)目名稱各不相同,主要有門(mén)診慢性病、門(mén)診特殊病、門(mén)診大病等;門(mén)診病種數(shù)量差異較大,多則幾十種,少則只有幾種。在13個(gè)研究地區(qū)的醫(yī)保門(mén)診政策中,職工醫(yī)保有12個(gè)地區(qū)將乙肝納入保障范圍,居民醫(yī)保只有5個(gè)地區(qū)納入乙肝,新農(nóng)合則有9個(gè)地區(qū)將乙肝納入范圍;各地政策規(guī)定的乙肝疾病類型也有所不同,一些地區(qū)包括所有乙肝相關(guān)疾病,有的地區(qū)只包括部分乙肝相關(guān)疾病,如肝硬化失代償期、重型肝炎等。不同地區(qū)之間、同一地區(qū)的不同醫(yī)保制度之間,醫(yī)保門(mén)診政策在就醫(yī)管理、籌資方式、待遇水平、支付方式上存在較大差異,呈現(xiàn)"碎片化"現(xiàn)象。結(jié)論乙肝患者直接經(jīng)濟(jì)負(fù)擔(dān)較重,存在醫(yī)療費(fèi)用結(jié)構(gòu)不合理,抗病毒治療率較低等問(wèn)題。乙肝患者的醫(yī)療保障水平有限,醫(yī)保政策差異大,缺乏一定的公平性。應(yīng)逐步完善醫(yī)療保障制度頂層設(shè)計(jì),縮小各地醫(yī)保政策差距,逐步將乙肝納入門(mén)診保障范圍并提高其待遇水平;同時(shí)規(guī)范乙肝診療行為,加強(qiáng)乙肝防治工作,以減輕乙肝患者經(jīng)濟(jì)負(fù)擔(dān),維護(hù)其健康權(quán)益。
[Abstract]:Objective to analyze the direct medical costs of the patients with hepatitis B and its composition, influence factors, to explore the implementation status of hepatitis B patients with medical insurance outpatient policy and existing problems, put forward reasonable measures to reduce the economic burden of hepatitis B patients, provide the basis for the improvement of medical insurance policy. Through the library, Internet, government platform to collect relevant documents in some areas of Jiangsu province outpatient medical insurance policy and management methods, and summarize and organize. Describe the 13 overall planning area of Jiangsu Province, health care workers, outpatient medical insurance policy situation of residents and the new rural cooperative medical insurance, including Medicare outpatient disease specific implementation of hepatitis B patients and security policy (salary payment etc.). Department of infectious disease in Jiangsu 2 grade three hospital infection of hepatitis B patients 50 and 3 grade three hospital clinicians 5 people were interviewed about hepatitis B The average per capita annual outpatient clinic visits and doctors on hepatitis B prevention and treatment guidelines > < the interpretation and application of Jiangsu province were selected. 2 level three hospital in 2014 1~12 months 14910 people outpatient hepatitis B patients and 966 hospitalized patients with hepatitis B as the study sample, obtain patients with direct medical costs and medical information from the hospital medical records system. Describe the clinic and direct medical costs for hospitalized patients with hepatitis B and its components are direct medical costs, annual outpatient costs, Medicare reimbursement fees and reimbursement; the direct medical costs of the patients with hepatitis B, hospitalization days were analyzed by single factor analysis of hospitalized patients with hepatitis B; the direct medical cost of multivariate linear regression analysis. The results of 1. patients with hepatitis B direct medical costs (1) 14910 people in outpatient patients with hepatitis B hepatitis B outpatient cases, 8952 male passengers (60.04%), 5958 female passengers (39.96%); 25~34 years of age Group visits the most (4131 times), accounting for 27.71%, at least 0~14 year old age group (56 people), accounting for 0.38% of Medicare patients; 9940 people (66.67%), the payment of 4970 patient visits (33.33%); in Medicare patients, health care workers were 9830 people (98.89%), residents Medicare patients 110 people (1.11%); patients with antiviral treatment rate was 37.46% and the rate of health care workers in patients treated with antiviral therapy (37.80%) than the residents of Medicare patients (29.09%) total.14910 million outpatient hepatitis B cases direct medical cost was 14188409.81 yuan. The average outpatient cost is 951.60 yuan, of which the highest proportion of drug costs (790.27 yuan), accounting for 83.05%; per capita outpatient visits for 12 years second, per capita outpatient expenditure was 11419.20 yuan; the average outpatient expenses (997.71 yuan) of male was higher than female (882.32 yuan), the difference was statistically significant (P0.05); 30~59 year old age group (980.33 yuan) the highest, the difference was statistically significant (P0.05); health care workers Patients (953.22 yuan) higher than the residents of Medicare patients (811.05 yuan), the difference was statistically significant (P0.05); antiviral therapy patients (1094.77 yuan) was higher than that in patients undergoing antiviral therapy (865.86 yuan), the difference was statistically significant (P0.05); patients with average reimbursement of 62.32%, health care workers (62.51%) higher than that of patients with medical insurance patients (42.76%), the difference was statistically significant (P0.05). (2) hospitalized inpatients with hepatitis B hepatitis B cases in 966 people, male 649 people (67.18%), 317 female passengers (32.82%); 25~34 patients up to age group (339 persons), accounting for 35.09%, 0~14 year old age group (at least 11 passengers), accounting for 1.14% of Medicare patients; 554 people (57.35%), the payment of 412 patient visits (42.65%). In the patients with medical insurance, health care workers were 526 people (94.95%), residents Medicare patients 28 people (5.05%); patients with antiviral treatment rate was 38.61% and the rate of health care workers (39.35% patients treated with antiviral therapy ) than the residents of Medicare patients (32.14%); the average hospitalization time was 24.78 + 16.81 days, up to 15~29 days of hospitalization group (416 persons), accounting for 43.06%, at least for at least 60 days hospitalization group (51 people), accounting for 5.28%; hospitalization days (median) male (21 days) than women (19 days), the difference was statistically significant (P0.05); Medicare patients (24 days) than to pay patients (17 days), the difference was statistically significant (P0.05); employee medical insurance patients (24 days) than residents of Medicare patients (22.5 days), the difference was statistically significant (P0.05).966 inpatient total direct medical costs of hepatitis B cases 12714108.85 yuan. The average hospitalization cost of 13161.60 yuan, of which the highest proportion of drug costs (9025.09 yuan), accounting for 68.57%; the average hospitalization cost of male was higher than female (13711.37 yuan) ($12036.05), the difference was statistically significant (P0.05); 30 or more days of hospitalization group (18255.02 yuan) higher than other days of hospitalization no group. There was statistical significance between group differences with hospitalization costs (P0.05); Medicare patients (14153.12 yuan) higher than that of patients with fee (11828.35 yuan), the difference was statistically significant (P0.05); patients with severe hepatitis B (17256.20 yuan) the highest, moderate hepatitis B patients (12827.62 yuan) of hepatitis B patients with mild (11628.48 yuan) the lowest. There was statistical significance between the groups of different disease severity, the cost difference (P0.05); antiviral therapy patients (13957.82 yuan) was higher than that in patients undergoing antiviral therapy (12660.78 yuan); the average reimbursement rate for 70.45% patients, health care workers (70.88% patients) than the residents of Medicare patients (60.95%), the difference was statistically significant (P0.05); multiple stepwise regression analysis showed that the degree of serious illness, hospitalization, antiviral treatment, settlement is the influence factors of hospitalization expenses (P0.05).2. outpatient medical insurance policy with hepatitis B status and CO ordinating the various health situation in Jiangsu Province The outpatient policy project name is different, the main chronic disease outpatient and outpatient special disease, serious illness; outpatient disease is great difference in the number of more than dozens of little. Only a few policy in 13 areas of outpatient medical insurance, health care workers in 12 areas will be included in the scope of protection of hepatitis B, Medicare residents only the 5 regions included hepatitis B, NCMS has 9 areas will be included in the scope of hepatitis B disease; around policy types are different, some areas including all HBV related diseases, including some areas only part of hepatitis B virus related diseases, such as cirrhosis, severe hepatitis. Among different regions, between different medical insurance system for the same a region, in the medical management of outpatient medical insurance policy, financing, the level of treatment, there is a big difference between the way of payment, showing the phenomenon of "fragmentation". Conclusion the direct economic burden of hepatitis B patients than Medical costs are heavy, unreasonable structure, low rate of antiviral therapy of hepatitis B patients. The level of medical care, health insurance policy differences, lack of fairness. We should perfect the top-level design of medical security system gradually, reduce the medical insurance policies will be gradually incorporated into the gap, hepatitis B outpatient insurance range and improve its level of treatment; at the same time specification for diagnosis and treatment of hepatitis B, hepatitis B to strengthen prevention and control work, to reduce the economic burden of patients with hepatitis B, safeguard the health rights.

【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.62;F842.684

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 翟祥軍;;從重大傳染病綜合防治示范區(qū)項(xiàng)目實(shí)施看我國(guó)乙肝防治重點(diǎn)[J];江蘇預(yù)防醫(yī)學(xué);2016年06期

2 張新升;包建民;劉美欣;;醫(yī)療機(jī)構(gòu)藥品費(fèi)用比例影響因素分析及控制措施[J];中國(guó)農(nóng)村衛(wèi)生事業(yè)管理;2016年09期

3 孔毅;許琳;康文玉;李瓊芬;;云南省1959-2014年病毒性肝炎流行特征分析[J];中國(guó)衛(wèi)生統(tǒng)計(jì);2016年04期

4 趙靜;;藥品價(jià)格改革問(wèn)題研究[J];衛(wèi)生經(jīng)濟(jì)研究;2016年07期

5 崔富強(qiáng);莊輝;;我國(guó)乙型肝炎防控工作進(jìn)展、挑戰(zhàn)及對(duì)策[J];中國(guó)病毒病雜志;2016年02期

6 李元霞;趙磊;張東航;王建國(guó);;我國(guó)異地就醫(yī)結(jié)算問(wèn)題分析[J];中國(guó)衛(wèi)生經(jīng)濟(jì);2016年03期

7 張鵬;聶紹發(fā);;2010—2014年湖北省乙型肝炎流行病學(xué)特征及發(fā)病趨勢(shì)分析[J];公共衛(wèi)生與預(yù)防醫(yī)學(xué);2016年01期

8 劉桂圓;張開(kāi)金;張華;馬永華;余有任;;乙型肝炎患者住院費(fèi)用與醫(yī)療保險(xiǎn)支付的典型相關(guān)分析[J];中國(guó)全科醫(yī)學(xué);2016年07期

9 呂秋華;石劍鋒;;三明市2004—2014年乙型肝炎流行病學(xué)分析[J];海峽預(yù)防醫(yī)學(xué)雜志;2016年01期

10 王霆;盧立云;王玉美;;2006-2014年淄博市臨淄區(qū)乙型病毒性肝炎流行特征分析[J];現(xiàn)代預(yù)防醫(yī)學(xué);2016年02期

相關(guān)博士學(xué)位論文 前1條

1 楊北方;湖北省人群乙型病毒性肝炎血清流行病學(xué)特征及乙肝疫苗效果分析[D];華中科技大學(xué);2013年

相關(guān)碩士學(xué)位論文 前6條

1 杭惠;2009-2014年蘇州市急性乙型肝炎流行病學(xué)特征分析[D];蘇州大學(xué);2015年

2 賀淑萍;肝病流行病學(xué)特征分析及慢性乙型肝炎癥狀分布示范研究[D];湖北中醫(yī)藥大學(xué);2015年

3 陳金彪;天津市參保乙肝患者住院費(fèi)用及個(gè)人負(fù)擔(dān)研究[D];天津醫(yī)科大學(xué);2013年

4 周立寧;城鎮(zhèn)職工門(mén)診慢性病基本醫(yī)療保險(xiǎn)監(jiān)管問(wèn)題研究[D];山東師范大學(xué);2013年

5 阿克忠;青海省2004-2010年乙型病毒性肝炎流行特征分析[D];山西醫(yī)科大學(xué);2012年

6 李寧寧;不同醫(yī)療保障制度下乙型病毒性肝炎三種病程患者的住院治療及費(fèi)用研究[D];山東大學(xué);2012年

，

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