分级诊疗背景下住院患者流向及费用分析——以安徽省城乡居民为例  

Analysis on inpatient flow and their cost under the background of hierarchical diagnosis and treatment system:a case study of urban and rural residents in Anhui Province

作　　者：孙谦 丁宏[1] 汪和平 荣健 刘雨阳 戈艳红 SUN Qian;DING Hong;WANG Heping;RONG Jian;LIU Yuyang;Ge Yanhong(School of Health Management,Anhui Medical University,Hefei 230032,China;Anhui Medical Security Bureau,Hefei 230062,China)

机构地区：[1]安徽医科大学卫生管理学院,安徽合肥230032 [2]安徽省医疗保障局,安徽合肥230062

出　　处：《福建医科大学学报（社会科学版）》2021年第4期14-17,22,I0001,共6页Journal of Fujian Medical University：Social Science Edition

基　　金：安徽医科大学医学人文研究中心课题(SK2018A0165)。

摘　　要：基于安徽省级医保信息平台获取36个县域城乡居民医保住院患者基础信息,统计描述住院患者的住院流向、住院费用和医保补偿基金分布等。2016—2019年,县域外住院人次占比分别为28.38%、30.79%、30.02%和30.24%;住院总费用、医保补偿基金和住院次均费用的年均增速分别为6.76%、11.34%和4.79%;县域外住院总费用、医保补偿基金占比最大且逐年增加;县域外住院补偿比逐年增加。从城乡居民医保住院患者就诊流向来看,分级诊疗效果尚未显现,医保补偿基金流向县域外的趋势未得到有效控制。应通过加强紧密型医共体建设,提高基层服务能力等措施,推进分级诊疗制度的落实。Based on the provincial medical insurance information platform,the data of inpatients with urban and rural medical insurance of the 36 counties in Anhui were collected,and accordingly the inpatient flow,the hospitalization cost and the distribution of medical insurance compensation fund were statistically analyzed.From 2016 to 2019,the percentages of hospitalization outside the county were from 28.38%to 30.79%.The mean annual growth rates of total hospitalization cost,medical insurance compensation fund and mean hospitalization cost were 6.76%,11.34%and 4.79%respectively.The proportions of total hospitalization cost and medical insurance compensation fund increased year by year.The inpatient compensation ratios ranged from 53.78%to 61.42%and increased year by year.Based on the perspective of inpatient flow tendency,the effect of hierarchical diagnosis and treatment system has not been shown yet,and the trend of medical insurance compensation fund flowing outside the county area has not been effectively controlled.Therefore,thd measures,like strengthening the construction of the close-knit medical treatment partnerships and improving the service capacity of medical institutions at the grassroots level should be taken to support the implementation of the hierarchical diagnosis and treatment system.

关 键 词：分级诊疗 城乡居民 病人流向 住院费用 安徽省 

分 类 号：R197.3[医药卫生—卫生事业管理] R197.1[医药卫生—公共卫生与预防医学]