某市公立医院门诊和住院患者医疗费用与支付方式的调查分析  

Medical Expenses of Outpatients and Inpatients in A Municipal Public Hospital and the Mode of Payment

作　　者：潘伦[1] 何坪[1] 吴海峰[1] 邓宇[1] 张维斌 潘传波 

机构地区：[1]重庆医药高等专科学校,重庆市401331 [2]重庆市卫生和计划生育委员会 [3]重庆市渝中区卫生局

出　　处：《中国全科医学》2014年第34期4127-4132,共6页Chinese General Practice

基　　金：重庆市卫生局委托项目(2012年);重庆市教委人文社会科学研究项目(2013)"重庆市公共医疗卫生资源配置及公平性研究"(13SKT05)

摘　　要：目的了解某市居民实际门诊和住院医疗的疾病类型、医保类型、医疗费用及费用支付方式现状,探讨基本医疗保障中存在的主要问题,并提出对策建议。方法将某市主城区公立医院分为一级医院、二级医院、三级医院三类,采用随机抽样方法,从三类医院中各抽取1家医院。2011年1—12月,从每月中随机抽取某1天,获取"门诊与出院患者及费用"等数据,分析现状和存在的问题。结果某市居民门诊平均总费用134.13元,其中自费117.39元,报销比例为12.48%。住院患者平均总费用4 123.38元,其中自费2 325.75元,报销比例为43.60%。药品费用占门诊医疗费用的比例为74.37%,占住院医疗费用的63.33%。三所公立医院按医院等级划分的门诊自费人次比例、门诊自费支付金额、门诊统筹支付金额、门诊药品费用、住院医保类型、住院医疗费用、住院医疗费用支付方面差异有统计学意义(P<0.05);按疾病划分的门诊医保类型、门诊医疗费用、门诊医疗费用支付、住院费用支付、住院医疗费用方面差异有统计学意义(P<0.05);诊疗相同的门诊疾病、住院疾病在费用和支付方式上差异也有统计学意义(P<0.05)。结论居民基本医疗的负担仍较重,医疗费用中药品比重较高,医疗保险支付方式较单一。建议建立基本药物统一采购、供应制度,各级医院同步使用基本药物,降低基本医疗费用;建立完善、科学的基本医疗保险支付体系,充分发挥医保资金的保障效率;建立基本医疗监管机制,防止资金滥用。Objective To learn the types of diseases and the types of medical insurances as well as the medical expenses and payment status quo of outpatients and inpatients in a city,explore the existing problems of basic medical security and put forward countermeasures and suggestions. Methods The municipal public hospitals were divided into three levels： First,Second and Third. A random sampling method was used to select one hospital from every level and then by the same method a random date was selected from each month of 2011. The data about the outpatients,inpatients and medical expenses on that day of each month were obtained respectively and analyzed in order to find the existing problems. Results The mean total cost per outpatient was$ 134. 13. Their private expense was $ 117. 39 and the reimbursement ratio was 12. 48%. The average total cost of hospitalized patients was $ 4 123. 38. The private expense was $ 2 325. 75 and the reimbursement ratio was 43. 60%. Pharmaceutical costs accounts for 74. 37% of outpatient expenditures and 63. 33% of inpatient expenditures. The differences in the proportion of self-paid patients,outpatient medical expenses,the amount of outpatient overall planning payment,outpatient medicine expenses,the types of hospitalization insurance, hospitalization medical expenses, hospitalization medical expenses payment among the three levels of hospitals were statistically significant（ P〈0. 05）; the types of outpatient medical insurance,outpatient medical expenses,outpatient medical expenses payment,hospitalization expenses,hospitalization medical expenses payment had obvious differences in terms of different diseases（ P〈0. 05）; the differences in expenses and payment mode between outpatient diseases and inpatient diseases with the same diagnosis were also statistically significant（ P〈0. 05）. Conclusion Residents basic medical burden is still heavier and the proportion of medicine expenses is also higher and the medical insurance payment mode is relatively single. It is suggest

关 键 词：卫生保健费用 医院 公立 门诊病人 住院病人 

分 类 号：R19[医药卫生—卫生事业管理]