天津市接收异地新型农村合作医疗跨省联网结报住院患者费用分析  

Investigation on the cross-province settlement of NCMS-covered inpatients in Tianjin： hospitalization cost analysis

作　　者：文光慧[1] 李诚[1] 

机构地区：[1]天津医科大学第二医院医疗保险办公室,300211

出　　处：《中华医院管理杂志》2018年第3期243-247,共5页Chinese Journal of Hospital Administration

摘　　要：目的对天津市三级医院接收异地新型农村合作医疗跨省联网结报住院患者费用进行分析，为政府部门完善相关政策提供依据。方法对2017年5—10月天津市23家三级医院接收的异地新型农村合作医疗住院患者联网结报数据进行跟踪统计和分析。不同来源地、不同疾病的患者费用组间比较，采用单因素方差分析，多重比较采用LSD—t检验。结果收集有来自辽宁省等8个省份的118例新型农村合作医疗患者就医联网结报费用，患者总人均发生费用为26744．92元，实际人均报销费用为8890．68元，占人均发生费用的33．24％。结论患者自费占比偏高，与各省份对三级医院补偿比例偏低、目录外医疗收费、自费医用材料使用等有关。应完善补偿政策和医保支付政策，确保各地新型农村合作医疗患者享有更合理的政策待遇。Objective To analyze the hospitalization costs of new rural cooperative medical system （NCMS）-covered inpatients received by tertiary hospitals in Tianjin with their expenses reimbursed in other localities, for reference of policy making by government departments. Methods NCMS-covered patients who were admitted by 23 tertiary hospitals from May to October in 2017 were followed up and analyzed using their online reimbursement data. Patient expenses were compared among groups of different sources and diseases, using one-way variance analysis and LSD-t for multiple comparison. Results The online reimbursement data of 118 NCMS-covered patients from eight provinces including Liaoning province were collected. The total cost per person averaged 26 744.92 yuan, with 8 890.68 yuan reimbursed, accounting for 33.24% of the expenses incurred. Conclusions The higher proportion of the out-of-pocket payment by patients＇ results from such factors as higher ratio of non-covered drugs, the lower compensation rate by other provinces on expenses at tertiary hospitals, the medical charges outside the catalog and the medical materials at own expense. Therefore, the compensation policy and medical insurance payment policy should be improved to ensure that the NCMS patients enjoy more reasonable policy treatment.

关 键 词：支付标准制定和审核 乡村卫生服务 全国联网 跨省结报 住院费用 

分 类 号：F323.89[经济管理—产业经济] F842.684[医药卫生—卫生事业管理] R197.32[医药卫生—公共卫生与预防医学]