中华医院管理杂志
中華醫院管理雜誌
중화의원관리잡지
CHINESE JOURNAL OF HOSPITAL ADMINISTRATION
2012年
11期
828-832
,共5页
茅雯辉%黄韻宇%陈文%刘桦%林坚
茅雯輝%黃韻宇%陳文%劉樺%林堅
모문휘%황운우%진문%류화%림견
基本医疗保险%恶性肿瘤%支付方式%住院费用%影响因素
基本醫療保險%噁性腫瘤%支付方式%住院費用%影響因素
기본의료보험%악성종류%지부방식%주원비용%영향인소
Primary medical insurance%Cancer%Payment package%Hospitalization expense%Impact factors
目的 分析按项目支付和限额支付方式下恶性肿瘤患者的住院费用,探索不同医疗保险支付方式对恶性肿瘤治疗费用的影响.方法 从郑州市和福州市的医疗保险数据库中,各随机抽取恶性肿瘤医保患者600名,统计分析其住院费用及其影响因素.结果 在按项目支付方式下,职工医保患者的费用水平高于居民医保患者,人均住院费用分别为32747.70±32035.01元和23035.83士22875.65元；而在限额支付方式下,两类医保患者住院费用差异不大,人均住院费用分别为66043.41士47562.09元和66576.54±73417.29元.结论 不同医疗保险的保障水平差异客观存在.在按项目支付方式下,保障的差异体现在次均费用的差别上；而在限额支付方式下,两类医保人群费用差异不大.建议合理利用支付方式,避免和减少由于医疗保障水平不同而造成的卫生服务利用的相对差异.
目的 分析按項目支付和限額支付方式下噁性腫瘤患者的住院費用,探索不同醫療保險支付方式對噁性腫瘤治療費用的影響.方法 從鄭州市和福州市的醫療保險數據庫中,各隨機抽取噁性腫瘤醫保患者600名,統計分析其住院費用及其影響因素.結果 在按項目支付方式下,職工醫保患者的費用水平高于居民醫保患者,人均住院費用分彆為32747.70±32035.01元和23035.83士22875.65元；而在限額支付方式下,兩類醫保患者住院費用差異不大,人均住院費用分彆為66043.41士47562.09元和66576.54±73417.29元.結論 不同醫療保險的保障水平差異客觀存在.在按項目支付方式下,保障的差異體現在次均費用的差彆上；而在限額支付方式下,兩類醫保人群費用差異不大.建議閤理利用支付方式,避免和減少由于醫療保障水平不同而造成的衛生服務利用的相對差異.
목적 분석안항목지부화한액지부방식하악성종류환자적주원비용,탐색불동의료보험지부방식대악성종류치료비용적영향.방법 종정주시화복주시적의료보험수거고중,각수궤추취악성종류의보환자600명,통계분석기주원비용급기영향인소.결과 재안항목지부방식하,직공의보환자적비용수평고우거민의보환자,인균주원비용분별위32747.70±32035.01원화23035.83사22875.65원；이재한액지부방식하,량류의보환자주원비용차이불대,인균주원비용분별위66043.41사47562.09원화66576.54±73417.29원.결론 불동의료보험적보장수평차이객관존재.재안항목지부방식하,보장적차이체현재차균비용적차별상；이재한액지부방식하,량류의보인군비용차이불대.건의합리이용지부방식,피면화감소유우의료보장수평불동이조성적위생복무이용적상대차이.
Objective To analyze the hospitalization expenses of cancer patients covered with byitem payment and quota payment packages,and probe into the impacts on such expenses for the two payment packages.Methods Inpatient records of 600 cancer patients were sampled by random from the medical insurance databases of Zhengzhou and Fuzhou to learn their hospitalization expenses and impact factors.Results Under the by-item payment package,the expenses of urban workers’ medical insurance were found higher than those of urban residents' medical insurance,with a per capita expense of RMB 32747.70 ± 32035.01 and 23035.83 ± 22875.65 respectively.Under the quota payment package however,there were no significant differences between expenses of the two kinds of inpatients,with a per capita expense of RMB 66043.41±47562.09 and 66576.54±73417.29 respectively.Conclusion There are gaps of reimbursement level between the two basic insurance schemes,which may not disappear in a short time.Under the by-item payment package,the gap exists in the difference of perreimbursement amount; under the quota payment package,the gap is negligible between the two populations under different insurance schemes.It is recommended to make reasonable use of these different payment schemes to minimize the relative gaps in medical service accessibility caused by the difference in reimbursement level.
