CAJ | 학술논문

目的：对海口市某医院老年慢性病患者医疗费用进行调查分析，为政府制定适宜的老年慢性病医疗费用控制政策提供参考。方法：选择海口市某医院2014年5－10月老年慢性病住院患者为调查对象，采用分层抽样的方法对该院5078例老年慢性病出院患者医疗费用进行统计分析。结果：医疗费用变化幅度和变异程度均较大，偏度系数由0．032到0．172，峰度系数由0．083到0．233，且单次住院费用中位数均小于次均住院费用，不同病种医疗费用差异较大。肿瘤患者的医疗费用个人负担比例最高，高血压患者个人负担比例最低；肿瘤患者的补助比例最高，心脏病患者的补助比例最低；不同文化程度、离退休职业、婚姻状况、医保形式的患者次均住院费用和自付比例有统计学差异（P＜0．05），不同性别的患者次均住院费用和自付比例无统计学差异（P＞0．05）。结论：医疗保险支付范围不宜采取次均费用的95％置信区间作为参考，可引入调和次均费用或者中位数作为参考依据；医疗保险政策应围绕疾病谱分布，综合运用单病种、总费用控制、项目计费等多种手段控制医疗费用不合理增长，合理使用医疗服务资源。
목적：대해구시모의원노년만성병환자의료비용진행조사분석，위정부제정괄의적노년만성병의료비용공제정책제공삼고。방법：선택해구시모의원2014년5－10월노년만성병주원환자위조사대상，채용분층추양적방법대해원5078례노년만성병출원환자의료비용진행통계분석。결과：의료비용변화폭도화변이정도균교대，편도계수유0．032도0．172，봉도계수유0．083도0．233，차단차주원비용중위수균소우차균주원비용，불동병충의료비용차이교대。종류환자적의료비용개인부담비례최고，고혈압환자개인부담비례최저；종류환자적보조비례최고，심장병환자적보조비례최저；불동문화정도、리퇴휴직업、혼인상황、의보형식적환자차균주원비용화자부비례유통계학차이（P＜0．05），불동성별적환자차균주원비용화자부비례무통계학차이（P＞0．05）。결론：의료보험지부범위불의채취차균비용적95％치신구간작위삼고，가인입조화차균비용혹자중위수작위삼고의거；의료보험정책응위요질병보분포，종합운용단병충、총비용공제、항목계비등다충수단공제의료비용불합리증장，합리사용의료복무자원。
Objective:To analyze the situation of medical expense distribution of the elderly with chronic diseases in a hospital in Haikou City, to provide the reference for the government to formulate appropriate policies on the elderly chronic disease prevention and management and cost control. Methods:Using stratified sampling method, the statistical analysis was conducted on the medical expenses of the hospitalized elderly with chronic diseases in a hospital of Haikou city from May to October in 2014. Results:The medical expenses of 6 chronic diseases changed with larger range and variation degree;the coefficient was from 0. 032 to 0. 172, and the kurtosis coefficient was from 0. 083 to 0. 233;the single hos?pitalization expenses'median were less than the second average hospitalization expenses, and the differences of different diseases'medical expenses were larger. Tumor patients'individual burden proportion of medical expenses was the highest, and the hypertension patients'was the lowest;the cancer patients'subsidy proportion was the highest, and that of the patients with heart disease was the lowest;the differences had significant differ?ence (P<0. 05) in patients'the second average hospitalization expenses and the self-paid ratio with different culture degree, retired professions, marriage situation, medical insurance types; patients with different genders in average hospitalization expenses and pay scale had no statistical difference (P>0. 05). Conclusion:The medical insurance payment should not take the mean costs'95% confidence interval as a reference;we can introduce the harmonic second average expenses and the median as a reference;the medical insurance policy should focus on the spectrum of disease distribution, use the single disease, total cost control, project accounting and other means to control the unreasonable growth of medical expenses to rationally use the medical service resources.