CAJ | 학술논문

目的：随着我国基本医疗保障制度的不断完善，医疗费用支付构成的合理性及影响因素受到越来越多的关注。文章分析城镇职工基本医疗保险住院患者医疗费用支付结构，研究影响住院费用支付构成的因素，探究控制医保患者住院费用的方法。方法对南京市某三级甲等综合医院2002至2012年医疗保险患者住院费用、费用组成、费用支付构成进行统计。对可能影响住院费用与支付构成的因素进行多元逐步回归分析。结果随着医保政策调整，住院费用中医保基金支付比例逐年增加，个人支付比例逐年减少。医保患者住院费用与支付构成受医保支付政策、社会人口学特征与疾病临床特征等多因素影响。结论通过可控因素的合理控制，加强参保人群健康教育、调整医保支付政策、推动双向转制度，从而有望实现卫生资源有效利用，达到合理控制医疗费用、减轻患者经济负担的目的。
목적：수착아국기본의료보장제도적불단완선，의료비용지부구성적합이성급영향인소수도월래월다적관주。문장분석성진직공기본의료보험주원환자의료비용지부결구，연구영향주원비용지부구성적인소，탐구공제의보환자주원비용적방법。방법대남경시모삼급갑등종합의원2002지2012년의료보험환자주원비용、비용조성、비용지부구성진행통계。대가능영향주원비용여지부구성적인소진행다원축보회귀분석。결과수착의보정책조정，주원비용중의보기금지부비례축년증가，개인지부비례축년감소。의보환자주원비용여지부구성수의보지부정책、사회인구학특정여질병림상특정등다인소영향。결론통과가공인소적합리공제，가강삼보인군건강교육、조정의보지부정책、추동쌍향전제도，종이유망실현위생자원유효이용，체도합리공제의료비용、감경환자경제부담적목적。
Objective The article was to analyze the payment structure of hospitalized urban employees receiving basic medi -cal insurance and the factors affecting the payment structure , resulting in measures to control the in-hospital fee of Medicare patients . Methods Statistical analysis was done on hospitalization expenses , expense composition and payment structure of hospitalized Medi-care patients in a first-class comprehensive hospital from 2002 to 2012 .The analysis of multiple stepwise regression were done on possi-ble influencing factors of hospitalization expenses and payment structure . Results With the adjustment of health policy , the propor-tion of medical insurance fund payment in the hospitalization expenses increased year by year , while the individual payment-scale re-duced accordingly .The hospitalization expenses and payment structure of Medicare patients were correlated with Medicare payment pol -icy, social demographic characteristics and clinical disease features . Conclusion By rational control on controllable factors , empha-sis on health care education , adjustment on Medicare payment policy and promotion on two way referral system , it is hopeful to realize the effective utilization of health resources , to achieve reasonable control on medical costs , and to reduce patients'economic burden .