黑龙江省乡镇卫生院住院医疗费用医保补偿水平研究  

Research on the Level of Inpatient Compensation from Medical Expenses with Medical Insurance in Township Health Centers of Heilongjiang Province

作　　者：郝洁靓 吴群红[1] 李叶[1] 梁立波[1] 高力军[1] 康正[1] 崔宇[1] 王澜[1] 梁梓[1] 潘远航[1] 

机构地区：[1]哈尔滨医科大学卫生管理学院,黑龙江哈尔滨150081

出　　处：《中国医院管理》2016年第6期44-46,共3页Chinese Hospital Management

基　　金：国家自然科学基金资助项目(71333003)

摘　　要：目的通过分析黑龙江省乡镇卫生院住院医疗费用,进而对医保补偿水平进行评价并就医保政策提出建议。方法从黑龙江省41个县域中随机抽样出3个不同经济水平的县域,对其所含各乡镇卫生院患者住院医疗费用从不同角度进行分类比较。结果黑龙江省乡镇卫生院住院费用医保补偿比水平较高(79.54%),其中慢性病补偿比最高(87.80%),肿瘤和消化系统疾病补偿比较低(分别为70.01%、65.33%),低保户84.61%的补偿比较正常人员78.86%的补偿比高。结论应当设置合理的疾病补偿结构,扩充医保福利包,优化分级诊疗制度;将重点从提高医保报销比例转移到多种医保类型的综合报销模式,改善农村居民享有医保的公平性,提高经济补偿水平。Objective Through the analysis of the hospitalization medical expenses of towns and townships in Hei- Iongjiang Province, to evaluate medical compensation level and put forward suggestions on medical insurance policy. Method From the 41 counties in Heilongjiang Province, 3 counties of different economic levels were chosen by random sampling. Comparison of their inpatients＇ medical expenses of all health clinics in towns and townships are compared from different angles. Result The level of inpatient compensation from medical expenses with medical insurance in township health centers of Heilongjiang Province is high, which is 79.54%. Chronic compensation is the highest, which is 87.80%. Compensations of digestive system disease and tumors are lower, which are 70.01% and 65.33% respectively. 84.61% of low-income residents＇ compensation is higher than 78.86% of normal personnel. Conclusion Reasonable compensation structure should be set up, medicare benefits package be expended, and hierarchic system of diagnosis and treatment be perfected; pursuing high compensation should be converted into a comprehensive compensation model, fairness of grassroots residents enjoying medical insurance be improved, and the level of economic compensation be raised.

关 键 词：住院医疗费用 乡镇卫生院 自付比例 补偿 

分 类 号：R197.62[医药卫生—卫生事业管理]