广东省某大型综合医院医保费用超支影响因素分析  

An Analysis of the Influence Factors of Guangzhou Medical Insurance Overspending

作　　者：姚瑶[1] 余治平[1] 杨敏敏[1] 王利颖[1] 吴晓琦[1] 邹晓旭[2] 田淼淼[3] 孙俊如[1] 

机构地区：[1]中山大学附属第三医院,广东广州510630 [2]中山大学附属第一医院,广东广州510630 [3]中国医学科学院医学信息研究所卫生政策与管理研究中心,北京100020

出　　处：《中国医院管理》2016年第3期69-71,共3页Chinese Hospital Management

基　　金：广东省医学科学技术研究基金资助课题(B2014067)

摘　　要：目的探索影响广州医保普通住院医保定额超支的因素。方法对某三甲综合医院2014年7月1日—2015年6月30日,对普通住院结算的广州医保参保人医保超支影响因素进行分析。结果年龄、人员类别、住院天数、是否抢救病人、是否手术、病例分型、入院途径是影响医保超支的危险因素。结论住院时间越长,入院途径不明确,医保超支的机率越大;年龄特征、人员类别诱发医保超支;其他来自政府、医保制度以及医院管理方面的因素影响医保超支。Objective This paper discussed the influence factors of Guangzhou medical insurance overspending for providing references of controlling medical insurance overspending. Methods Using χ^2 test and logistic regression to analyze the influence factors of medical insurance overspending for hospitalization patients from July 1 2014 to June 31 2015 in arbitrary class-A hospital. Results The risk factors of medical insurance overspending included the age, hospitalization patients class, day of hospitalization, rescuing patients, operation, case class and hospitalization diagnosis. Conclusion The longer time of hospitalization and the more ambiguous hospitalization diagnosis, the bigger chance of medical insurance overspending rate; the characteristic of age and personnel category induced medical insurance overspending; the factors from government, medical insurance system and management of medical hospital affected medical insurance overspending.

关 键 词：普通住院 医保超支 影响因素logistic回归 

分 类 号：R197.32[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]