门诊医保患者就诊流向与费用分析  

Research on the Distribution of Outpatients and the Analysis of Medical Expenditure

作　　者：许赛男[1] 熊光练[1] 赵金辉[1] 

机构地区：[1]华中科技大学同济医学院医疗保险研究中心,湖北武汉430030

出　　处：《中国社会医学杂志》2011年第2期131-132,135,共3页Chinese Journal of Social Medicine

摘　　要：目的了解门诊医保患者就诊流向和费用情况,找出影响门诊医保患者就医流向和费用的主要因素,为引导病人合理分流、合理控制门诊费用提供相应的政策和依据。方法采用随机抽样方法抽取襄樊市403名门诊医保患者进行问卷调查,对结果进行单因素与多因素相结合的分析。结果三级医院门诊人数比例39.8%,二级医院34.2%,一级医院26.0%,而影响各等级医院门诊总费用的主要因素是家庭月收入和教育程度。结论门诊资源利用效率不高、浪费严重;二、三级医院还是门诊患者的主要选择;门诊费用居高不下,社区资源闲置。建议在医院和社区之间合理分流门诊患者,政府予以政策倾斜,拉大各等级医疗机构之间的医保报销比例范围。Objectives Through the questionnaire to the medical flow and expenditures of outpatients in Xiangfang City,to find the major influencing factors of outpatients' flow and costs in order to guide patients' rational triage and provide reasonable policies and basis of controlling medical expenditures.Methods With a random sampling method,403 outpatients were collected and investigated,single and multiple factors were used for analysis of the data.Results The study reflected the unreasonable flow of outpatients in this city,3A hospital took 39.8%,2A hospital took 34.2% and 1A hospital only took 26.0% respectively.The main factors influencing the outpatients' total expenditures were family income and education level.Conclusions This research showed the inefficiency and serious waste of medical resources currently.2A and 3A hospitals are still the primary choices of outpatients,high outpatients' costs and idle community resources,therefore,this study suggested that made a reasonable out-patient' flow between hospital and community,widening the range of reimbursement ratio in each medical institution under the government policy inclination.

关 键 词：医疗保险 门诊患者分流 门诊费用 

分 类 号：R197.1[医药卫生—卫生事业管理]