不同医保类型老年人脑血管病住院患者自付费用研究  

Study on out-of-pocket expenses of senior inpatients with cerebrovascular diseases under different types of medical insurance

作　　者：杨荣晓 孙进 李雪文 张彦茹 贾善群 朱伟[1] 孙长青[1] YANG Rong-xiao;SUN Jin;LI Xue-wen;ZHANG Yan-ru;JIA Shan-qun;ZHU Wei;SUN Chang-qin(School of Public Health,Zhengzhou University,Zhengzhou,Henan 450001,China)

机构地区：[1]郑州大学公共卫生学院,河南郑州450001

出　　处：《现代预防医学》2021年第18期3370-3373,3378,共5页Modern Preventive Medicine

基　　金：中国人口死亡模式变化的新特征与发展趋势研究(20BRKO41)。

摘　　要：目的分析不同医保类型老年人脑血管病的保障水平,为降低患者经济负担和优化医保支付方式提供依据。方法收集河南省2018年3月1日—2018年6月30日主要诊断为脑血管病患者共35711例,运用描述统计、独立样本t检验、单因素方差分析方法进行统计分析。结果住院患者总体自付比例为18.37%,整体效果较好,但不同医保类型自付比例差距大;不同医保类型自付费用构成中药费占比最高(39.5%),其次为诊断费(29.46%);城乡居民医保颅内出血、脑梗死和其他脑血管病自付比例分别为20.2%、20.36%、21.3%,均高于城镇职工,差异具有统计学意义(P<0.001);两种医保自付比例在不同住院费用分组间的差异具有统计学意义(P<0.001),当住院费用大于1.5万元时,城镇职工医保自付比例随住院费用的增高而增高,城乡居民医保自付比例随住院费用费用升高而降低。结论政府可以通过提高医保统筹层次,优化医保费用结构,构建多元化医保监管体系,健全城乡居民医保保障体系等措施控制患者自付费用,优化医保支付方式。Objective To analyze the insurance level of cerebrovascular diseases in the elderly with different types of medical insurance,and to provide basis for reducing the economic burden of patients and optimizing the payment method of medical insurance.Methods A total of 35711 patients with major cerebrovascular disease diagnosed from March 1,2018 to June 30,2018 in Henan Province were collected and analyzed by descriptive statistics,independent sample t-test and one-way analysis of variance.Results The overall out-of-pocket proportion of inpatients was 18.37%,the overall effect was good,but there was a big difference in the out-of-pocket proportion of different medical insurance types.The out-of-pocket expenses of different insurance types accounted for the highest proportion of traditional Chinese medicine(TCM)costs(39.5%),followed by the diagnosis cost(29.46%).The out-of-pocket rates of intracranial hemorrhage,cerebral infarction and other cerebrovascular diseases for urban and rural residents were 20.2%,20.36%and 21.3%,respectively,which were higher than those for urban workers,and the difference was statistically significant(P<0.001).The difference of the two kinds of insurance out-of-pocket ratio among different groups of hospitalization expenses was statistically significant(P<0.001).When the hospitalization cost was more than 15000 yuan,the out-of-pocket ratio of medical insurance for urban workers increased with the increase of the hospitalization cost,and the out-of-pocket ratio of medical insurance for urban and rural residents decreased with the increase of the hospitalization cost.Conclusion The government can control the out-of-pocket expenses of patients and optimize the payment methods of medical insurance by improving the pooling level of medical insurance,optimizing the structure of medical insurance cost,building a diversified medical insurance regulatory system,and improving the medical insurance security system for urban and rural residents.

关 键 词：医保类型 脑血管病 自付费用 自付比例 

分 类 号：R197.1[医药卫生—卫生事业管理]