上海市个人现金卫生支出分析对降低医疗费用的启示  

Analysis of out-of-pocket health payments in Shanghai and its implications for reducing medical expenses

作　　者：李芬[1,2] 王常颖[1] 张晓溪[1] 王力男[1,3] 丁玲玲[4] 贺志敏[4] 金春林[1,5] 

机构地区：[1]上海市医学科学技术情报研究所.上海市卫生发展研究中心,上海200040 [2]复旦大学公共卫生学院,上海200032 [3]上海财经大学,上海200433 [4]中南大学湘雅公共卫生学院,湖南长沙410008 [5]上海市人口与发展研究中心,上海201199

出　　处：《卫生经济研究》2017年第12期3-8,共6页

基　　金：上海市第四轮公共卫生三年行动计划重点学科建设项目"循证公共卫生与卫生经济学"(15GWZK0901)

摘　　要：在卫生费用核算框架下,运用矩阵平衡法,综合筹资方案支付数据和医疗卫生机构收费数据,核算2015年上海市个人现金卫生支出(OOP)总量及不同类型人员的OOP负担,为降低居民医疗费用负担提供循证依据。结果显示:2015年,上海市常住居民OOP占经常性卫生费用的比例为38.13%,老年人医疗费用自付比例较低,在医院就诊的自付比例远高于在社区就诊,循环系统疾病、恶性肿瘤、损伤和中毒等疾病类型自付比例较高。可见,上海市居民OOP负担仍较高,并存在人群之间不公平现象。建议从卫生系统的"筹资、支付、组织、规制"等控制键出发,提高卫生资金使用效率,降低患者OOP。Under the framework of health cost accounting, the Shanghai’s total amount of out-of-pocket health payments（OOP） and the OOP burden of different kinds of people in 2015 were calculated to provide evidence to reduce cost burden using matrix balance method. The results showed that the 38.13 percent of the total regular health expenditure in Shanghai was OOP of permanent residents. The percent of out of pocket among elderly was low, with lower in community centers than hospitals. The percent of out of pocket was higher among circulatory system disease, malignant tumor, type of injury and poisoning disease. Thus it can be seen that OOP burden is still high among Shanghai residents and there are inequities among the different groups. It is suggested to improve the utilization efficiency of health funds and reduce the OOP of patients from the perspective of financing, payment,organization and regulation.

关 键 词：卫生费用核算 个人现金卫生支出 医疗费用负担 

分 类 号：R197[医药卫生—卫生事业管理]