总额预付制下上海市某二级医院的医疗费用分析  

Analysis of Medical Expenses in a Second Level Hospital Under Global Budget Payment System in Shanghai

作　　者：钱泽慧 侯志远[1] 吴擢春[1] 华孙英 Qian Zehui(School of Public Health,Fudan University,Key Lab of Health Technology Assessment,National Health Commission,Collaborative Innovation Center of Social Risks Governance in Health,Shanghai,20003)

机构地区：[1]复旦大学公共卫生学院国家卫生和健康委员会卫生技术评估重点实验室国民健康社会风险预警协同创新中心,上海200032 [2]上海市嘉定区中心医院,上海201800

出　　处：《医学与社会》2018年第10期5-7,14,共4页Medicine and Society

基　　金：国家自然科学基金青年项目;编号为71403007;上海市嘉定区卫计委委托课题"上海市嘉定区二级医院医疗费用合理性评价及其原因分析"

摘　　要：目的:通过对上海市某二级医院2010-2015年期间医疗业务、医疗费用及其构成以及医保补偿情况进行分析,探讨该院医疗费用控制的效果,为卫生部门决策提供参考。方法:对医院医疗业务和费用、医保费用相关指标和趋势进行描述性统计分析。结果:医院医疗服务量总体增长趋势缓慢,2013年门急诊量出现负增长,2014-2015年出院患者量持续负增长。2010-2015年间,平均住院日从11.28天降至8.96天;药占比从40.71%下降至34.07%;医保支出中均次费用贡献比逐年增加。结论:总额预付制下该院医疗费用总体增长缓慢,临床路径有效地控制了平均住院日,住院服务模式由依赖药品和检查向注重治疗服务转变,医疗费用控制良好。Objective： To explore the effect of controlling the medical expenses through analyzing the medical services, medical expenses and its constitution, and the compensation of health insurance in a secondary comprehensive hospital in Shanghai from 2010 to 2015, so as to provide suggestions for further policy improvement. Methods： Descriptive statistical analysis was carried out on the related indicators of hospital medical services, expenses and health care expenditure as well as their general trend of change. Results： The overall growth trend of hospital medical service volume was slow, and there was a negative growth in outpatient emergency in 2013. In 2014-2015, the number of discharged patients continued to grow negatively. In 2010-2015, the average hospitalization day for discharged patients fell from 11.28 days to 8.96 days, the proportion of medicines dropped from 40.71% to 34.07%, and the contribution rate of the cost-per-consumption of medical insurance expenditures increased year by year. Conclusion： Under Global Budget Payment System, the growth rate of medical expenses was slow, the clinical pathway effectively controled the average hospital stay, the mode of hospitalization was transformed from dependence on drugs and inspection to treatment services. The cost of medical expenses were well controlled.

关 键 词：医疗费用 总额预付制 二级医院 

分 类 号：R197.323[医药卫生—卫生事业管理]