广西基本医疗保险住院费用支出与待遇保障水平比较研究  

Comparative Study on Hospitalization Expenses and the Level of Protection of Entitlements of the Basic Medical Insurance in Guangxi Province

作　　者：刘哲敏 冯启明 李宏亨 赵歆妍 刘伟 蒋柳婷 黄永耀 张伟艺 梁雷颖 罗萍[3] 罗红叶 LIU Zhe-min;FENG Qi-ming;LI Hong-heng(School of Information and Management,Guangxi Medical University,Nanning,530021,China;不详)

机构地区：[1]广西医科大学信息与管理学院,南宁530021 [2]广西医疗保险研究会,南宁530022 [3]广西医科大学附属口腔医院,南宁530021

出　　处：《中国卫生经济》2021年第4期49-52,共4页Chinese Health Economics

基　　金：2020年健康与经济社会发展研究中心课题(2020RWB06);广西教育科学规划课题(KF2014014);广西医科大学教育教学改革项目(2020XJGA18)。

摘　　要：目的:分析广西基本医疗保险住院医疗支出和待遇保障基本情况,为广西基本医疗保险基金支出管理提供决策参考。方法:采用广西2017—2019年报数据,分析城镇职工和城乡居民医保住院费用和待遇保障相关指标的变化情况。结果:两保险的次均住院费用差距有所缩小;3年内两保险的住院总费用持续增长,且占医疗总费用比例较高;虽然3年来二者待遇差距有所缩小,但城镇职工医保的住院统筹支付比例和次均补偿费用更高。结论:住院控费效果不明显,两保险待遇仍存在差距,城乡居民医保基金负担较重,应控制住院费用增长,改变城乡居民医保筹资机制,注重医保基金开源节流,遏制过度利用住院服务的行为,提高医保基金使用效率。Objective: To analyze the basic situation of Guangxi basic medical insurance hospitalization expenditure and treatment level, so as to provide decision-making reference for Guangxi basic medical insurance fund management. Methods: Based on Guangxi’s2017—2019 annual report data, the changes in medical insurance hospitalization expenses and treatment levels of urban employees and urban and rural residents are analyzed. Results: The gap between the average hospitalization expenses of these two insurances has been narrowed;the total cost of hospitalization for both insurances increases steadily over the three-year period and accounts for a high proportion of total medical expenses;although the treatment gap between these two insurances has been narrowed over the past three years, urban employee health insurance still has a higher overall hospitalization payment ratio and sub-average compensation costs. Conclusion: The effect of hospitalization fee control is not obvious, and there is still a gap between these two insurance benefits. The burden on urban and rural residents’ health insurance funds is relatively heavy. The increase in hospitalization expenses should be controlled, the financing mechanism of urban and rural residents’ health insurance should be changed, and emphasis should be placed on cutting costs and cutting expenses from the health insurance funds, curbing the overuse of hospitalization services and improving the efficiency of the use of health insurance funds.

关 键 词：城镇职工医疗保险 城乡居民医疗保险 住院费用 待遇水平 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R840.613