定额结算下淮安市住院分娩费用变化及费用结构实证分析  

An empirical analysis on the change and structure of hospitalization delivery expenses in Huai’an under the fixed settlement

作　　者：史文欣 周杰华[2] 殷璐[2] SHI Wen-xin;ZHOU Jie-hua;YIN Lu(Huai'an Second People's Hospital,Huai'an Jiangsu 223002,China;Taizhou People's Hospital,Taizhou Jiangsu 225300,China)

机构地区：[1]淮安市第二人民医院,江苏淮安223002 [2]泰州市人民医院,江苏泰州225300

出　　处：《卫生软科学》2021年第11期59-62,共4页Soft Science of Health

基　　金：国家自然科学基金(71704032);江苏省医院协会医院管理创新研究课题(JSYGY-3-2021-59)。

摘　　要：[目的]分析淮安市住院分娩费用及其结构变化情况,为控制住院分娩费用的过快增长和生育保险支付方式的调整提供参考。[方法]对2016-2020年淮安市住院分娩基本情况、费用变化、报销比例等采用描述性统计分析。[结果]2016-2020年,该市剖宫产率平均为48.21%,住院分娩费用平均为5808.29元;孕产妇住院分娩自付金额平均为1778.37元,自付比例平均为30.83%。2016-2020年,费用占比下降最多的是西药费(下降了3.69%),其次是化验费(下降了2.19%);费用占比上升最多的是手术麻醉费(增长了3.89%),其次是检查费(增长了2.93%)。[结论]住院分娩费用呈上升趋势,且剖宫产组费用要明显高于顺产组;西药费、治疗费、手术麻醉费和化验费四项构成了住院分娩费用的主体,且手术麻醉费、西药费和检查费是影响住院费用变化的主要因素。Objective This paper analyzes the changes and structure of hospitalization delivery expenses in Huai’an so as to provide reference for controlling excessively rapid growth of hospitalization delivery costs and adjusting payment method of maternity insurance. Methods Descriptive statistical analysis was used to analyze basic situation, the change of expenses and reimbursement ratio of hospitalization delivery. Results From 2016 to 2020,average cesarean section rate in this city was 48.21%,which average hospitalized delivery cost was 5808.29 yuan, average out-of-pocket payment was 1778.37 yuan, and the average out-of-pocket proportion was 30.83%. The proportion of most decline cost was western medicine fee which decreased by 3.69%,next was laboratory test fee which decreased by 2.19%;The proportion of most increase cost was operation anesthesia fee which increased by 3.89%,next was examination fee which decreased by 2.93%. Conclusions Hospitalization delivery expenses is on the rise, and the cost of cesarean section group is more than that of eutocia group. Western medicine, treatment, operation anesthesia and laboratory test fee constitute principal part of hospitalization delivery expenses, and western medicine, operation anesthesia and examination fee are main factors of affecting the changes of hospitalization expenses.

关 键 词：住院分娩 顺产 剖宫产 费用构成 生育保险 定额结算 

分 类 号：R714.3[医药卫生—妇产科学] R714.4[医药卫生—临床医学]