医疗保险患者住院医疗费用分布特点  

Distribution Characteristics of In-patient Medical Expenditure with Medical Insurance

作　　者：陈琳[1] 杨国斌[1] 杨宝林[1] 刘玉秀[1] 陈海云[1] 戚苗苗[1] 王与荣[1] 

机构地区：[1]南京军区南京总医院医务部,南京210002

出　　处：《解放军医院管理杂志》2009年第8期766-768,共3页Hospital Administration Journal of Chinese People's Liberation Army

基　　金：南京军区"十五"医药科研基金课题(05MA003)

摘　　要：目的:分析医疗保险住院患者系统疾病费用分布特点。方法:对某医院2003-2006年构成前10个系统疾病医保出院患者进行统计,报告其住院总费用、例数、均数、标准差、中位数、最小值、第5百分位数、第25百分位数、第75百分位数、第95百分位数、最大值,并计算各系统第95百分位数以上的平均费用,累计费用及占总费用比例。结果:疾病医疗费用呈非正态分布。第95百分位数以上5%大额病例费用,占全部患者总住院费用比例达21.5%～29.9%。结论:医疗保险患者医疗费用的分布有其特殊性;医疗费用定额支付标准应根据疾病医疗费用分布特点和医疗服务需求强度制定。Objective： To analyze the distribution characteristics of hospitalization expenses of systemic diseases in patients with medical insurance. Methods： The first 10 systemic diseases of the inpatients with medical insurance were enrolled in the study. The average expenses of each systemic disease were investigated. Results ： The inpatient medical expenditure of each systematic disease changed significantly （P 〈0. 001 ）. The square chart of overall in- patient medical expenditure of the first 10 systematic diseases presented that the distribution was positively skewed. The box chart of inpatient medical expenditure showed that strange and extreme values exist in the payment of each systematic disease. The average percentage of high -cost patients＇ payment covering 5% of the first 10 inpatient systematic diseases in the overall payment was in the range of 21.5% -29.9%. Conclusion： The distribution of inpatient medical expenditure with medical insurance has its characteristics. The medical fixed quotas payment should be standardized according to the distribution characteristics of inpatient medical expenditure.

关 键 词：医疗保险 定额结算 住院医疗费用 

分 类 号：R197.32[医药卫生—卫生事业管理]