医保患者个人和统筹支付费用的影响因素分析  

Analysis of influencing factors on the individual and pooling funds payment of medical insurance patient

作　　者：贾琼[1] 李长平[1] 崔壮[1] 顾丽丽[1] 宋振[1] 马跃屾[1] 陈金彪[1] 马骏[1] 

机构地区：[1]天津医科大学公共卫生学院卫生统计教研室,天津300070

出　　处：《现代预防医学》2013年第14期2642-2645,共4页Modern Preventive Medicine

基　　金：教育部人文社会科学研究青年基金项目(11YJCZH080);全国统计科学研究计划项目(2009LY048;2009LY011)

摘　　要：目的了解天津市医保肝硬化住院患者个人支付和统筹支付费用的影响因素,探索降低住院费用的策略,为建立有效的费用控制机制提供依据。方法从天津市2003～2007年医保住院患者资料库中抽取肝硬化患者2341例,对其住院费用中的个人支付和统筹支付构成情况进行分析。组间比较采用秩和检验,用多元逐步回归方法对不同支付方式的影响因素进行分析。结果影响两种支付方式费用的主要因素均有住院天数,医院类别和治疗方式,人员类别还影响个人支付费用。住院日越长,医院级别越高,手术治疗患者个人支付和统筹支付费用越高,在职人员个人支付费用高于退休人员。结论政府、医院和医保机构各方面需协同努力,统一的诊疗常规基础之上考虑年龄、病情、治疗方式等因素而制定肝硬化的单病种收费标准,可以有效地降低肝硬化患者的个人及统筹支付费用。OBJECTIVE To study the influencing factors on the individual and pooling funds payment of medical insurance cirrhosis inpatient in Tianjin so as to explore the perfect tactics of reducing medical expense and offer the theoretic and practical evidence for establishing effective expense control mechanism. METHODS 2 341 cirrhosis inpatients with medical insurance from 2003 to 2007 were collected randomly from the database, the hospitalization expenses of individual payment and pooling funds payment constitution were analyzed. Compared among groups with the nonparametric test, the influencing factors of the expense of two different payment methods were analyzed by multiple linear regression method. RESULTS Length of stay, hospital level and the way of treatment were the main factors affecting the funds payment, the factors influencing individual payment were the same as funds payment, apart from the occupation. The expense of individual payment and funds payment were positively correlated with the number of hospitalization days, the grade of the hospital and the ratio of operation fee. Individual payment in in-service staff was higher than that in retirees. CONCLUSION Government, hospitals and medical insurance institutions need a concerted effort. Effective measures, such as instituting the charge criterion of specific entity based on common therapeutic standard, considering factors such as age, patient’s condition and the way of treatments at the same time should be taken to reduce the individual payment and pooling funds payment of cirrhotic patients.

关 键 词：医保患者 肝硬化 个人支付 统筹支付 影响因素 

分 类 号：R195.1[医药卫生—卫生统计学]