城鄉(xiāng)居民醫(yī)療保險費用比較分析及其影響因素研究
發(fā)布時間：2018-11-01 18:33
【摘要】：目的從2003年以來，河北省先后建立了針對農(nóng)村居民的新型農(nóng)村合作醫(yī)療和針對城鎮(zhèn)非從業(yè)居民的城鎮(zhèn)居民基本醫(yī)療保險。但由于這兩種醫(yī)保政策管理程序、參保人群、保障待遇等多方面規(guī)定都不相同，導(dǎo)致城鄉(xiāng)居民住院醫(yī)療費用間存在差距。本文對河北省某縣城鎮(zhèn)居民基本醫(yī)療保險和新型農(nóng)村合作醫(yī)療的實施情況進(jìn)行分析，在此基礎(chǔ)上對兩種不同醫(yī)療保險制度下，患者的住院醫(yī)療費用進(jìn)行比較研究，深入了解住院費用的構(gòu)成和影響因素，探討導(dǎo)致住院醫(yī)療費用上漲的主要原因，進(jìn)而提出控制住院醫(yī)療費用增長的控制措施，為完善城鄉(xiāng)居民醫(yī)療保障制度提供參考。 方法資料來源于河北省某縣醫(yī)療保險中心、新農(nóng)合管理系統(tǒng)，選取該縣2011年1月到2011年12月31日本地住院的城鎮(zhèn)居民醫(yī)保患者和新農(nóng)合患者，，作為研究對象。收集患者個人詳細(xì)信息及住院費用的相關(guān)數(shù)據(jù)，將患者所有資料錄入excel建立數(shù)據(jù)庫，對患者人口學(xué)資料、住院費用基本情況和構(gòu)成情況進(jìn)行一般性統(tǒng)計描述，住院費用構(gòu)成包括住院總費用、藥費、治療費、檢查費、手術(shù)費、特檢費和床位費，比較兩種醫(yī)療保障制度下患者住院費用的差別；采用SPSS19.0統(tǒng)計軟件對住院費用的影響因素進(jìn)行單因素和多因素分析。主要采用的統(tǒng)計方法有Mann-Whitney U檢驗、 Kruskal-Willas H檢驗、多元逐步回歸分析。 結(jié)果1住院醫(yī)療費用構(gòu)成中，城鎮(zhèn)居民醫(yī)保患者的藥費、治療費和檢查費的構(gòu)成比是53.76%、13.29%和9.91%；新農(nóng)合患者的藥費、治療費和檢查費為52.95%、15.86%和12.05%，分別排在兩種醫(yī)�；颊咦≡嘿M用的前三位。2住院醫(yī)療費用支付方式上，城鎮(zhèn)居民醫(yī)保患者個人支付比例12.54%，統(tǒng)籌支付比例87.46%；新農(nóng)合患者個人支付比例和統(tǒng)籌支付比例分別為33.60%和66.40%。3城鎮(zhèn)居民醫(yī)�；颊吆托罗r(nóng)合患者住院費用比較：城鎮(zhèn)居民醫(yī)保患者的平均住院費用（2069.77元）高于新農(nóng)合患者平均住院費用（1936.11元）；城鎮(zhèn)居民醫(yī)�；颊叩乃庂M、檢查費、特檢費和手術(shù)費均高于新農(nóng)合患者，差別有統(tǒng)計學(xué)意義（P＜0.05）。4城鎮(zhèn)居民醫(yī)�；颊咦≡嘿M用的影響因素有年齡、住院天數(shù)、有無手術(shù)和醫(yī)院級別。患者年齡越大，住院時間越長，住院費用越高；進(jìn)行手術(shù)和大型檢查項目使得患者住院費用增高；就診于二級醫(yī)院的患者住院費用高于基層一級醫(yī)院。5新農(nóng)合患者住院費用的影響因素為性別、年齡、住院天數(shù)、有無大型檢查、有無手術(shù)和醫(yī)院級別。男性患者住院費用明顯高于女性患者；住院時間越長，患者住院費用越多；不同年齡組的患者間住院醫(yī)療費用有差異，差別具有統(tǒng)計學(xué)意義（P＜0.05）；手術(shù)患者住院費用高于非手術(shù)患者；就診于二級醫(yī)院患者住院費用高于一級醫(yī)院患者。 結(jié)論1不同醫(yī)療保障制度下，城鎮(zhèn)居民醫(yī)�；颊叩淖≡嘿M用高于新農(nóng)合患者。2新農(nóng)合統(tǒng)籌基金補償水平低于城鎮(zhèn)居民醫(yī)保，有待進(jìn)一步提高。3根據(jù)病情選擇就診醫(yī)院，在明確診斷的前提下，嚴(yán)格掌握用藥指征和手術(shù)適應(yīng)癥，降低住院天數(shù)，減少藥費比重，能減少住院費用，減輕患者個人及統(tǒng)籌基金支付壓力。
[Abstract]:Objective Since 2003, Hebei province has established a new rural cooperative medical system for rural residents and basic medical insurance for urban residents of non-residents in cities and towns. However, because these two kinds of health insurance policy management procedures, the insured people, the safeguard treatment and so on various regulations are different, resulting in the gap between the medical expenses between the urban and rural residents. This paper analyzes the implementation of the basic medical insurance and the new rural cooperative medical system in a county of Hebei Province. On the basis of this, the medical expenses of the patients are compared and studied in two different medical insurance systems, and the composition and influencing factors of hospitalization expenses are deeply understood. This paper discusses the main causes of the increase in hospital medical expenses, and then puts forward the control measures to control the increase of hospital medical expenses and provides reference for perfecting the medical insurance system of urban and rural residents. Methods From January 2011 to December 31, 2011, the medical insurance center and Xinong Joint Management System of a county in Hebei Province were selected. Object: Collect relevant data of patient's personal details and hospitalization expenses, input all the data in the patient to excel to establish a database, make general statistical description of patient demographic data, basic conditions and composition of hospitalization expenses, including total hospitalization expense, medical expense, treatment The difference of hospitalization expenses of patients under the two medical security systems was compared with the treatment fee, examination fee, operating fee, special examination fee and bed position fee. The factors influencing the hospitalization cost were single factor and multi-factor. Analysis. The main statistical methods were Mann-Whitney U test, Kruskal-Willas H test, multivariate stepwise regression. Results 1 The composition ratio of medical expenses, treatment fee and examination fee for medical insurance patients of urban residents was 53. 76%, 13. 29% and 9. 91%. The medical expenses, treatment cost and examination fee of Xinong patients were 52. 95%, 15. 86% and 1. 2. 05%, in the first three of the two medical insurance patients' hospitalization expenses. In the way of hospital medical expenses payment, the proportion of personal payment of urban residents' medical insurance patients was 12.54%, and the proportion of total payment was 8. 7. 46%; the proportion of individual payment and the overall payment proportion of the new farmers are 33. 60% and 66. 40%, respectively. The average hospitalization expenses of urban residents' medical insurance patients (2069. 77 yuan) are higher than the average hospitalization expenses of new farmers (1936). (11) The medical expenses, examination fee, special inspection fee and operating expenses of medical insurance patients of urban residents were higher than those of new farmers. The difference was statistically significant (P <0.05). The influencing factors of hospitalization expenses for urban residents of urban residents were age, number of hospitalization days, and operation. The higher the patient's age, the longer the hospital stay, the higher the hospitalization cost, the higher hospitalization cost of patients who underwent surgery and large-scale examination, the hospitalization cost of patients with secondary hospitals was higher than that of the primary-level hospital. Sex, age, number of days in hospital, presence or absence of large-scale examination, presence or absence of surgery The hospitalization cost of male patients was significantly higher than that in female patients, the longer the hospitalization time, the higher the hospitalization cost of patients, the difference in hospitalization expenses among patients with different age groups, the difference was statistically significant (P <0.05). Non-surgical patients; hospitalization expenses for patients with secondary hospital higher than 1 Conclusion 1 In different medical security systems, the cost of hospitalization for urban residents in medical insurance is higher than that of new farmers. The compensation level of new non-agricultural integrated fund is lower than that of urban residents, which needs to be further improved. Under the precondition of definite diagnosis, strictly master the medication finger sign and surgical indication, reduce the number of hospitalization days, reduce the specific gravity of medical expenses, reduce hospitalization expenses, reduce the patient's personal and
【學(xué)位授予單位】：河北聯(lián)合大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R197.1;F842.684
本文編號：2304746
[Abstract]:Objective Since 2003, Hebei province has established a new rural cooperative medical system for rural residents and basic medical insurance for urban residents of non-residents in cities and towns. However, because these two kinds of health insurance policy management procedures, the insured people, the safeguard treatment and so on various regulations are different, resulting in the gap between the medical expenses between the urban and rural residents. This paper analyzes the implementation of the basic medical insurance and the new rural cooperative medical system in a county of Hebei Province. On the basis of this, the medical expenses of the patients are compared and studied in two different medical insurance systems, and the composition and influencing factors of hospitalization expenses are deeply understood. This paper discusses the main causes of the increase in hospital medical expenses, and then puts forward the control measures to control the increase of hospital medical expenses and provides reference for perfecting the medical insurance system of urban and rural residents. Methods From January 2011 to December 31, 2011, the medical insurance center and Xinong Joint Management System of a county in Hebei Province were selected. Object: Collect relevant data of patient's personal details and hospitalization expenses, input all the data in the patient to excel to establish a database, make general statistical description of patient demographic data, basic conditions and composition of hospitalization expenses, including total hospitalization expense, medical expense, treatment The difference of hospitalization expenses of patients under the two medical security systems was compared with the treatment fee, examination fee, operating fee, special examination fee and bed position fee. The factors influencing the hospitalization cost were single factor and multi-factor. Analysis. The main statistical methods were Mann-Whitney U test, Kruskal-Willas H test, multivariate stepwise regression. Results 1 The composition ratio of medical expenses, treatment fee and examination fee for medical insurance patients of urban residents was 53. 76%, 13. 29% and 9. 91%. The medical expenses, treatment cost and examination fee of Xinong patients were 52. 95%, 15. 86% and 1. 2. 05%, in the first three of the two medical insurance patients' hospitalization expenses. In the way of hospital medical expenses payment, the proportion of personal payment of urban residents' medical insurance patients was 12.54%, and the proportion of total payment was 8. 7. 46%; the proportion of individual payment and the overall payment proportion of the new farmers are 33. 60% and 66. 40%, respectively. The average hospitalization expenses of urban residents' medical insurance patients (2069. 77 yuan) are higher than the average hospitalization expenses of new farmers (1936). (11) The medical expenses, examination fee, special inspection fee and operating expenses of medical insurance patients of urban residents were higher than those of new farmers. The difference was statistically significant (P <0.05). The influencing factors of hospitalization expenses for urban residents of urban residents were age, number of hospitalization days, and operation. The higher the patient's age, the longer the hospital stay, the higher the hospitalization cost, the higher hospitalization cost of patients who underwent surgery and large-scale examination, the hospitalization cost of patients with secondary hospitals was higher than that of the primary-level hospital. Sex, age, number of days in hospital, presence or absence of large-scale examination, presence or absence of surgery The hospitalization cost of male patients was significantly higher than that in female patients, the longer the hospitalization time, the higher the hospitalization cost of patients, the difference in hospitalization expenses among patients with different age groups, the difference was statistically significant (P <0.05). Non-surgical patients; hospitalization expenses for patients with secondary hospital higher than 1 Conclusion 1 In different medical security systems, the cost of hospitalization for urban residents in medical insurance is higher than that of new farmers. The compensation level of new non-agricultural integrated fund is lower than that of urban residents, which needs to be further improved. Under the precondition of definite diagnosis, strictly master the medication finger sign and surgical indication, reduce the number of hospitalization days, reduce the specific gravity of medical expenses, reduce hospitalization expenses, reduce the patient's personal and
【學(xué)位授予單位】：河北聯(lián)合大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R197.1;F842.684
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 鄭大喜;醫(yī)療服務(wù)價格調(diào)整與醫(yī)療費用控制的關(guān)系研究[J];現(xiàn)代醫(yī)院管理;2005年03期
2 李國鴻;加拿大醫(yī)療保險模式及其發(fā)展評析[J];國外醫(yī)學(xué)(衛(wèi)生經(jīng)濟分冊);2005年01期
3 劉寧;;梁山縣農(nóng)民住院衛(wèi)生服務(wù)利用及其影響因素[J];醫(yī)院管理論壇;2008年04期
4 馮啟明;綜合性醫(yī)院醫(yī)保與非醫(yī)�；颊咦≡簷z查費用的多因素分析[J];廣西醫(yī)科大學(xué)學(xué)報;2004年01期
5 傅萬明,常啟太,徐少青,魯立,梅同華;外科單病種平均住院日調(diào)查分析與對策[J];中國醫(yī)院統(tǒng)計;1998年03期
6 唐蕓霞;;醫(yī)療費用增長對醫(yī)療保險基金的影響及對策研究[J];江西財經(jīng)大學(xué)學(xué)報;2007年04期
7 計阿丹;肖倩;馬晨東;肖永紅;;河北省城鄉(xiāng)醫(yī)保居民心血管疾病住院醫(yī)療費用構(gòu)成及影響因素分析[J];鄭州大學(xué)學(xué)報(醫(yī)學(xué)版);2014年02期
8 ;部分省級綜合醫(yī)院病種平均住院日和費用排序及分析[J];中國衛(wèi)生經(jīng)濟;1992年10期
9 劉克軍,王梅;我國慢性病直接經(jīng)濟負(fù)擔(dān)研究[J];中國衛(wèi)生經(jīng)濟;2005年10期
10 岳金華;肖永紅;閆子海;;腦卒中疾病醫(yī)�；颊咦≡横t(yī)療費用的影響因素分析[J];現(xiàn)代預(yù)防醫(yī)學(xué);2008年01期
相關(guān)碩士學(xué)位論文 前3條
1 吳清;乳腺癌病人住院費用及影響因素研究[D];山東大學(xué);2007年
2 楊道威;人口老齡化對醫(yī)療保險統(tǒng)籌基金支出的影響研究[D];華中科技大學(xué);2008年
3 曲偉;北京農(nóng)村居民醫(yī)療費用現(xiàn)況及影響因素研究[D];北京中醫(yī)藥大學(xué);2010年
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