【摘要】：目的：本文通過對云南省某三甲醫(yī)院2007-2011年醫(yī)保與自費患者住院費用的相關資料進行統(tǒng)計分析,了解醫(yī)保與自費患者住院費用的差異,深入了解住院費用的構成、變化趨勢及其影響因素,同時分析導致住院費用不合理增長的原因,為有效控制住院費用提供科學依據,同時也為當地醫(yī)藥衛(wèi)生管理部門和醫(yī)療保險機構制定單病種付費標準提出合理的意見與建議。 方法：采用回顧性調查研究的方法。從昆明市8所三級甲等醫(yī)院里隨機選擇一所作為調查對象,收集該院2007年1月至2011年12月神經內科出院的所有腦梗死患者的病例,得到有效病歷2403例。以病歷首頁的基本信息為依據,調查患者的社會經濟學特征、疾病特征和診療質量等指標,從醫(yī)院信息中心收集住院費用的相關數據。所有資料在Epidata3.1中建立數據庫及校對,數據分析使用SPSS17.0統(tǒng)計軟件,運用描述性分析,卡方檢驗、秩和檢驗、相關性分析和多元回歸分析等統(tǒng)計分析方法,對獲取的資料進行歸納、整理與分析。 結果： 1.2007-2011年醫(yī)保組與自費組住院費用在總體上呈上漲趨勢。 2.在住院患者總費用上,醫(yī)保組的費用中位數9690.66元,高于自費組的8421.46元。經檢驗,兩者之間差異有統(tǒng)計學意義(P0.001)。 3.藥費和檢查費均為醫(yī)保組與自費組住院費用的重要組成部分,藥費和檢查費的控制是有效控制住院費用增長的關鍵點。 4.醫(yī)保組與自費組的平均住院天數均高于全國三級醫(yī)院12.4天的平均水平。 5.醫(yī)保組住院費用的主要影響因素為檢查費比例、住院天數、是否做手術、護理級別、是否使用乙類藥品和年齡等。自費組的主要影響因素為住院天數、檢查費比例、搶救次數、檢技比和年齡等。 值得注意的是檢查費比例對總體住院費用、醫(yī)保組和自費組住院費用的影響都較大,需進一步深入研究。 結論： 1.應該控制住院費用的不合理增長,特別注意醫(yī)�；颊咦≡嘿M用的控制。 2.醫(yī)療費用支付方式對費用增長有影響,應該完善醫(yī)療保險制度,改善醫(yī)療費用支付方式。 3.進一步加強對藥費和檢查費等費用的控制,減少過度醫(yī)療。 4.采取各種有效措施縮短無價值住院日,能有效降低住院費用。 5.根據不同人群的費用特點和影響因素,增強控制措施的針對性,能夠更好地保證醫(yī)保政策各項目標的早日實現。 6.按單病種預付費是促進醫(yī)院科學管理、合理檢查用藥、尋找合理治療流程的有效途徑。
[Abstract]:Objective: in order to understand the difference of hospitalization cost between medical insurance and self-paid patients and the composition of hospitalization expenses, this paper makes statistical analysis on the related data of medical insurance and self-paid patients' hospitalization expenses in a tertiary first class hospital in Yunnan Province in 2007 / 2011, so as to find out the difference between medical insurance and self-paid patients' hospitalization expenses. At the same time, the causes of unreasonable increase of hospitalization expenses are analyzed to provide scientific basis for effective control of hospitalization expenses. At the same time, it also puts forward reasonable opinions and suggestions for local medical and health administration departments and medical insurance institutions to make single disease payment standard. Methods: the methods of retrospective investigation were used. 2403 cases of cerebral infarction were collected from 8 Grade 3A hospitals in Kunming from January 2007 to December 2011, and 2403 effective medical records were obtained from the patients who were discharged from the department of neurology from January 2007 to December 2011. Based on the basic information on the first page of medical records, the socio-economic characteristics, disease characteristics and diagnosis and treatment quality of the patients were investigated, and the data of hospitalization expenses were collected from the hospital information center. All the data were set up and proofread in Epidata3.1. The data analysis used SPSS17.0 statistical software, descriptive analysis, chi-square test, rank sum test, correlation analysis and multivariate regression analysis, and other statistical analysis methods, such as descriptive analysis, chi-square test, rank sum test, correlation analysis and multiple regression analysis, etc. Summarize, collate and analyze the obtained data. Results: 1. The hospitalization expenses of the medical insurance group and the self-paid group showed an increasing trend in 2007 / 2011. 2. In the total cost of inpatients, the median cost of the medical insurance group was 9690.66 yuan, which was higher than that of the self-paid group of 8421.46 yuan. The difference between the two was statistically significant (P0.001). 3. The cost of medicine and examination are both important components of the hospitalization cost of the medical insurance group and the self-expense group. The control of the drug cost and the examination fee is the key point to effectively control the increase of the hospitalization cost. 4. The average hospitalization days of the medical insurance group and the self-paid group were higher than the national average of 12.4 days in the tertiary hospitals. 5. The main influencing factors of hospitalization cost in the medical insurance group were the ratio of examination fee, the length of stay in hospital, whether to perform operation, nursing grade, use of class B drugs and age, and so on. The main influencing factors of the self-paid group were the days of hospitalization, the ratio of examination fees, the times of rescue, the ratio of inspection techniques and the age and so on. It is worth noting that the ratio of check-up fee has a great influence on the total hospitalization cost, the medical insurance group and the self-paid group, which needs to be further studied. Conclusions: 1. We should control the unreasonable increase of hospitalization expenses, pay special attention to the control of hospitalization expenses of medical insurance patients. 2. The way of payment of medical expenses has influence on the increase of expenses, so we should perfect the system of medical insurance and improve the way of payment of medical expenses. 3. Further strengthen the cost of drug and inspection control, reduce over-treatment. 4. Take all kinds of effective measures to shorten the value of hospitalization days, can effectively reduce the cost of hospitalization. 5. According to the cost characteristics and influencing factors of different groups, the pertinence of the control measures can be strengthened to ensure the early realization of the objectives of the health insurance policy. 6. Advance payment according to single disease type is an effective way to promote the scientific management of hospital, to examine and use drugs reasonably and to find a reasonable treatment flow.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R197.3;F842.684

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1 張毓輝;萬泉;翟鐵民;王從從;郭鋒;魏強;柴培培;趙郁馨;;2011年中國衛(wèi)生總費用核算結果與分析[J];中國衛(wèi)生經濟;2013年01期

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本文編號：2448927