2014年全国基本医疗保险参保患者年度医疗费用负担分析  

Analysis on the Annual Medical Burden of Primary Medical Insurance Participants

作　　者：崔斌[1] 王丽莉[2] 

机构地区：[1]北京大学公共卫生学院卫生政策与管理学系,北京100191 [2]中国医疗保险研究会,北京100716

出　　处：《中国卫生经济》2016年第2期35-37,共3页Chinese Health Economics

摘　　要：目的:分析参保患者的年度医疗费用总负担及个人费用负担。方法:利用2014年全国34个城市基本医疗保险参保患者医疗服务利用抽样调查数据进行分析。结果:参保患者年人均医疗费用总负担为5 383元,主要集中于高级别医疗机构;人均个人费用负担为1 828元,约占总费用负担的34%;住院负担比重高于门诊负担;职工医保患者总负担是居民医保患者的2.40倍,但其个人负担比例远低于居民医保。结论:要积极推进分级诊疗,引导常见病门诊和住院向基层医疗机构分流,减轻医疗费用总体负担;同时要加强医疗服务监管,提高医疗服务利用的合理性,减少不必要花费。Objective： To analyze the annual medical expenditure and individual cost burden of the insurance participants. Meth- ods： Using the data of 34 cities from the National Medical Service Utilization Sample Survey for the Basic Medical Insuranee（BMI） par- ticipants in 2014. Results： The average annual medical expenditure was 5 383 yuan for BMI participants, mainly centered in high-lev- el medical institutions; per capita individual expenditure burden was 1 828 yuan, accounted for 34% of the total expenditure burden; the proportion of hospitalization burden was higher than outpatient burden; the total burden of employee medical patient was 2.40 times of resident medical insurance patients, but the individual burden ratio was higher than resident medical insurance. Conclusion： It needed to positively promote grading diagnosis and treatmentm guide the allocation of common disease outpatient and hospitalization to be treated in primary hospitals and alleviate the total medical burden. Meanwhile, the medical service supervision should be en- hanced to improve the rationality of medical services and decrease the unnecessary expenditures.

关 键 词：基本医疗保险 医疗服务利用 医疗费用负担 

分 类 号：R197.1[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学]