2007—2012年深圳市沙井街道社区健康服务中心劳务工医疗保险门诊费用调查研究  

Investigation on Outpatient Expenditure of Labor Workers Medical Insurance in Shenzhen Shajing Street Community Health Service Center in 2007—2012

作　　者：欧阳芳芳 叶定村 林敏文 练亮宇 

机构地区：[1]广东省深圳市宝安区沙井人民医院社区健康服务管理中心,518104

出　　处：《中国全科医学》2013年第36期4314-4316,共3页Chinese General Practice

基　　金：深圳市宝安区科技创新局资助项目--社康中心的劳务工医保患者就诊现状分析(2013166)

摘　　要：目的 探讨深圳市劳务工医疗保险（医保）门诊费用的使用现状,为进一步完善劳务工医保政策提供理论依据.方法 统计分析2007-2012年深圳市沙井人民医院社区健康服务管理中心的统计年表,即深圳市沙井街道社区健康服务中心劳务工医保门诊费用的业务报表.主要分析报表中的劳务工医保门诊费用支出情况和劳务工医保门诊包干基金使用情况.结果 （1）2007-2012年劳务工医保门诊数量呈先增加后减少,2009年达到高峰（90.54万人次）,比2007年（45.67万人次）增加了98.25%.每年的门诊总费用、医保记账费用（除2010年比2009年稍低外）、药品费用均呈逐年上升趋势.6年的医保记账比例在69.88%～74.68%,药品费用比例在38.28%～43.24%.门诊次均费用呈先降低后增加,2009年最低（38.34元）,比2007年（52.24元）降低了26.61%;2012年最高（56.63元）,比2009年上涨了47.70%.（2）2007-2012年劳务工医保绑定人数在347.36万人～400.59万人,2008年最多,2009年突然较2008年（400.59万人）下降了11.50%;2012年最少（347.36万人）,比2008年下降了13.29%.2007、2008年劳务工门诊包干基金分别结余579.90万元和283.62万元,但2009年以后劳务工门诊包干基金连续4年出现亏损,基金结余分别为-392.82万元、-131.14万元、-22.25万元、-110.97万元.结论 深圳市劳务工医保门诊费用低廉,基本解决了劳务工看病贵的问题.目前,医保包干基金处于亏损的现状,故政府还应加大劳务工医保的投入,进一步完善劳务工医保制度和建立符合社区卫生服务特点的薪酬制度.Objective To investigate the situation of outpatient costs of medicare for labor workers in order to provide a theory evidence for further improvement of labor workers medical insurance policy. Methods The annual report from Shajing Street Community Health Service Center in 2007--2012, namely the outpatient expenditure of labor workers medical insurance was analyzed. The outpatient expenditures of labor workers medical insurance and contract fund were specifically analyzed. Results （ 1 ） From 2007 to 2012, the number of labor workers with medicare in outpatient was firstly increased and reached the peak in 2009 （905 400 person -time, an increase of 98.25% compared with 2007 ） , but was then decreased. Total cost of outpatient and medical insurance billing cost showed an annual growth （2010 slightly lower than 2009 ） . Drug cost also showed an increas- ing trend during the six years. The medicare recording rate during the six years was 69. 88% to 74. 68% , and proportion of drug cost was 38.28% to 43.24% of the total cost. The per capita cost of labor workers medical insurance outpatient expenditure was between 38.34 yuan （2009, a decrease of 26. 61% compared with 2007） to 56.63 yuan （2012, an increase of 47. 70% com- pared with 2009） in six years. （2） From 2007 to 2012, the number of labor workers with medicare was between 3 473 600 （2012） and 4 005 900 （2008） . The number was decreased 11.50% in 2009 over 2008. The surplus of contract fund in 2007and 2008 was 5 799 000 yuan and 2 836 200 yuan respectively. But after 2009, the fund had deficit for four consecutive years, with a surplus of- 3 928 200 yuan, - 1 311 400 yuan, -2 22 500 yuan and - 1 109 700 yuan respectively. Conclusion Al- though labor workers medical insurance system has basically solved the basic medical problems in Shenzhen City for the majority of migrant workers, however, as for the medical insurance contract fund loss problem, the government should increase investment for the labor workers medical insurance in

关 键 词：保险 健康 社区卫生服务 卫生保健费用 门诊病人 劳务工 

分 类 号：R191.2[医药卫生—卫生事业管理]