安徽4个地区城乡居民医保整合后参保患者住院费用分析  

Analyze the effect of urban and rural medical insurance integration on the hospitalization expenses of the insured in 4 areas of Anhui

作　　者：张冰 黄凤明 余蕾 周洋洋 ZHANG Bing;HUANG Fengming;YU Lei;ZHOU Yangyang(Medical Insurance Office,The First Affiliated Hospital of USTC,Anhui Provincial Hospital,Hefei,Anhui,230001,China;Human Resource Office,The First Affiliated Hospital of USTC,Anhui Provincial Hospital,Hefei,Anhui,230001,China;Discipline Inspection and Supervision Office,The First Affiliated Hospital of USTC,Anhui Provincial Hospital,Hefei,Anhui,230001,China)

机构地区：[1]中国科学技术大学附属第一医院、安徽省立医院医保处,安徽合肥230001 [2]中国科学技术大学附属第一医院、安徽省立医院人事处,安徽合肥230001 [3]中国科学技术大学附属第一医院、安徽省立医院纪检监察室,安徽合肥230001

出　　处：《江苏卫生事业管理》2020年第9期1196-1199,共4页Jiangsu Health System Management

基　　金：安徽省社会科学创新发展研究课题(2019CX022)。

摘　　要：目的:通过分析比较城乡居民医保整合前后六安市、滁州市、合肥市、蚌埠市4个地区的参保患者在安徽省某三甲医院的住院费用,探索医保整合后的实施效果。方法:采用多阶段整群抽样的方法,抽取安徽省某三甲医院住院患者中来自六安市、滁州市、合肥市、蚌埠市4个地区的参保患者,再分别抽取各地市医保整合前、后各一年内的住院患者,将医保整合前、后的住院患者分别列为对照组和实验组,分析比较两者医保支付费用、个人支付费用、药占比、医疗费用等因素的差异。结果:城乡居民医保整合后(实验组)与整合前(对照组)相比,医保支付比例提高(t=51.14,P<0.01)、个人支付比例降低(t=-64.96,P<0.01)、药占比降低(t=-4.29,P<0.01)、均次住院费用略有提高(t=2.24,P<0.01),差异具有统计学意义。结论:目前安徽省部分地市实行的城乡医保的整合,报销比率在政策层面提升较为明显,保障能力比城乡医保整合前要高,一定程度上减轻了城乡居民的疾病负担。Objective:To analyze the hospitalization costs of insured patients a certainGrade-A Tertiary general Hospital in Anhui Province before and after the integration of urban and rural residents’medical insurance before and after the integration of medical insurance in Lu’an City,Chuzhou City,Hefei City,and Bengbu City,to explore the effect of the implementation of urban and rural medical insurance.Method:Multi-stage cluster sampling method was used to select insured patients from Lu’an City,Chuzhou City,Hefei City,and Bengbu City among inpatients in a certainGrade-A Tertiary general Hospital in Anhui Province,then sample the patients in each city before and after the medical insurance integration within one year,the patients before and after the medical insurance integration are listed as the control group and the experimental group,respectively analyze and compare the differences inmedical insurance payment costs,personal payment costs,drug proportion,medical expenses and other factors.Results:After the integration of urban residents’medical insurance(experimental group)compared with before integration(control group),the medical insurance payment ratio increased(t=51.14,P<0.01),the ratio of personal payment ratio decreased(t=-64.96,P<0.01),the proportion of medicines decreased(t=-4.29,P<0.01)andthe average hospitalization cost increased slightly(t=2.24,P<0.01),and the difference was statistically significant.Conclusion:At present,the integration of urban and rural medical insurance in some prefectures and cities in Anhui Province,the reimbursement ratio is more obvious at the policy level,and the guarantee capacity is higher than before the integration of urban and rural medical insurance,which reduces the disease burden of urban and rural residents to a certain extent.

关 键 词：城乡居民医保 整合 住院费用 分析 

分 类 号：R197.1[医药卫生—卫生事业管理]