CAJ | 학술논문

目的：通过对上海市三级医院总额预付制实施前后医疗业务量、床位效率、医疗费用及医保相关指标变化进行分析，探讨上海市现行的医保支付制度的现状和问题，评价总额预付制实施对医疗服务数量、效率和费用的作用和影响。方法利用 SPSS 21.0对上海市三级医院医疗业务量、医疗服务效率、医疗费用相关指标在总额预付制实施前后的变化趋势进行描述性统计分析。结果实施总额预付制后，上海市三级医院门急诊人次和出院人数同比增幅均下降约4.0%；2012年较2008年平均住院日共减少4.0天；医疗总费用同比增幅从总额预付制前(21.7%)下降至2012年12.6%；2010年后，医保门急诊人次和出院人次同比不断增加；医保总费用占总费用的比例均低于39.0%，且逐年降低；医保预算核定总量累计完成率每年均高于100.0%，每年均超支；医保药品核定总量累计完成率每年均低于100.0%。结论实施总额预付制后，医疗业务量不断上升，医疗服务效率不断提高，医疗费用控制效果显著，医保患者医疗服务质量有待提高，医保预算总额费用有待进一步控制。
목적：통과대상해시삼급의원총액예부제실시전후의료업무량、상위효솔、의료비용급의보상관지표변화진행분석，탐토상해시현행적의보지부제도적현상화문제，평개총액예부제실시대의료복무수량、효솔화비용적작용화영향。방법이용 SPSS 21.0대상해시삼급의원의료업무량、의료복무효솔、의료비용상관지표재총액예부제실시전후적변화추세진행묘술성통계분석。결과실시총액예부제후，상해시삼급의원문급진인차화출원인수동비증폭균하강약4.0%；2012년교2008년평균주원일공감소4.0천；의료총비용동비증폭종총액예부제전(21.7%)하강지2012년12.6%；2010년후，의보문급진인차화출원인차동비불단증가；의보총비용점총비용적비례균저우39.0%，차축년강저；의보예산핵정총량루계완성솔매년균고우100.0%，매년균초지；의보약품핵정총량루계완성솔매년균저우100.0%。결론실시총액예부제후，의료업무량불단상승，의료복무효솔불단제고，의료비용공제효과현저，의보환자의료복무질량유대제고，의보예산총액비용유대진일보공제。
Objective To analyze such indices as quantity of care,bed turnover,medical costs and medical insurance in Shanghai′s tertiary hospitals,before and after the implementation of the global budget for a study of the present medical insurance payment in Shanghai.Methods With SPSS 21.0,this thesis conducted a descriptive statistic analysis on changes of such indices as service volume,and efficiency in medical services,medical costs,before and after the implementation of the global budget.Results After the implementation,the year-on-year growth of the number of outpatients and emergency visits,and patients discharged decreased about 4.0%in such hospitals.From 2008 to 2012,the average days of stay dropped by 4.0 days in total.Before the implementation,the growth rate of total costs of medical services was 21.7%,which was only 12.6%in 2012.For those patients under coverage,the number of outpatients and emergency visits,and inpatients discharged kept increasing since 2010.The ratio of total medical insurance cost in the total medical costs fell below 39.0%,dropping year on year.The accumulated completion rate of medical insurance is over 100.0%each year,with overspending each year as well,and such total for drugs covered by medical insurance falls below 100.0%each year.Conclusion The global budget helps push up volume and efficiency of medical services,and helps control medical expense significantly.However,quality of care for patients is expected to improve,and so is further control over the total amount of global budget.