医保患者10种系统疾病大额住院医疗费用分析  

Analysis of high hospitalization expenses of medical insurance patients with 10 systemic diseases

作　　者：陈琳[1] 刘玉秀[1] 杨宝林[1] 杨国斌[1] 

机构地区：[1]南京军区南京总医院医务部,江苏南京210002

出　　处：《医学研究生学报》2009年第9期968-971,975,共5页Journal of Medical Postgraduates

基　　金：南京军区医药卫生科研基金资助项目(批准号:05MA003)

摘　　要：目的：为了合理控制大额病例医疗费用,对医疗保险（简称＂医保＂）住院患者系统疾病大额住院费用进行分析。方法：针对某医院2003年1月至2006年12月构成前10个系统疾病的医保出院患者分别进行描述性统计,计算各系统疾病第95百分位数以上的平均费用、累计费用及占总费用比例等,并与全部患者进行对比分析。结果：第95百分位数以上病例（即5%大额病例）费用占全部患者总住院费用比例达21.5%-29.9%;5%大额病例人均住院费是系统疾病平均值的4.3-6.0倍;患者支付金额占住院费的30.8%-54.9%;住院日是平均值的1.5-4.7倍。结论：5%大额病例住院费占该全部患者医疗费用近1/4。应采取综合措施,合理控制大额病例医疗费用。Objective ： This study aimed to analyze the high medical expenses of hospitalized medical insurance patients for the first ten systemic diseases. Methods： We investigated the medical expenses for the first ten systemic diseases among 10 900 hospitalized medical insurance patients of a hospital, calculated the average expenses and total payment for the treatment of each of the systemic diseases that involved 5% of the total patients, computed their percentage in the total expenses, and compared them with those of all the other hospitalized cases. Results ： The medical cost of the 5% of the first 10 hospitalized systemic diseases accounted for 21% -29.9% of the total expenses of all the hospitalized patients, 4.3 -6.0 times that of the average expenses, and 30.8% -54.9% paid by the patients themselves. In addition, the hospital stay of these patients was 1.5 - 4.7 times that of the average. Conclusion ： The high medical expenses involving 5% of the hospitalized patients with the first 10 systemic diseases amounted to a quarter of those paid by all the hospitalized patients. Effective measures have to be taken to keep high hospitalization expenses at a reasonable level.

关 键 词：医疗保险 大额病例 住院医疗费用 

分 类 号：R197.1[医药卫生—卫生事业管理]