潍坊市2015—2019年度基本医保住院病人费用流向分析及政策探讨——利用结构变动度的数据统计分析方法  

Flow analysis and policy discussion on basic medical insurance inpatient expenses in Weifang City from 2015 to 2019:A statistical analysis with structure variation

作　　者：陈延爱 刘峥 单苗苗 王晓晗 王培承[4] 高倩倩[2] 于晓伟 马少波 CHEN Yanai;LIU Zheng;SHAN Miaomiao;WANG Xiaohan;WANG Peicheng;GAO Qianqian;YU Xiaowei;MA Shaobo(Weifang Medical Security Bureau,Weifang,Shandong 261061,China;Weifang Medical University,Weifang,Shandong 261053,China;Weifang Medical Insurance Center,Weifang,Shandong 261061,China)

机构地区：[1]潍坊市医疗保障局,山东潍坊261061 [2]潍坊医学院,山东潍坊261053 [3]潍坊市医疗保险事业中心,山东潍坊261061 [4]潍坊医学院公共卫生学院党委,山东潍坊261053

出　　处：《中国农村卫生事业管理》2021年第11期776-781,共6页Chinese Rural Health Service Administration

摘　　要：目的分析潍坊市2015—2019年度基本医保住院病人住院费用结构变化情况,把握基本医保住院病人费用流向和基金流向,为构建合理诊疗秩序、控制参保人群医疗总费用过快增长以及提高基本医保基金使用效益提供依据。方法采用结构变动度、结构变动值和结构变动贡献率等指标,从住院总费用及其分项目两个层面进行统计分析。结果2015—2019年,职工医保、居民医保住院总费用在三级医疗机构占比逐年增高。全体参保人住院总费用结构变动度为13.89%,参保职工住院总费用结构变动度为16.75%,参保居民住院总费用结构变动度为13.69%。三级医疗机构各项目结构变动贡献率最高。一级医疗机构和二级医疗机构个人自负呈负向变动,其余项目呈正向变动。结论参加基本医保的病人向更高级别医院流动的趋势明显,医疗总费用大幅度上涨,建议通过完善支付方式改革来提升基金使用效益,遏制医疗总费用不合理增长。Objective To analyze the structure variation of hospitalization expenses under basic medical insurance in Weifang City from 2015 to 2019,and to provide references for figuring out the expense flow and fund flow of insured inpatients,constructing rational health care order,controlling the excessive growth of the insured population’s total healthcare expenses and improving the utilization efficiency of basic medical insurance funds.Methods The structural variation degree,structural change and structural variation contribution rate were applied to conduct a statistical analysis from the aspects of total hospitalization expenses and sub-items of hospitalization expenses.Results From 2015 to 2019,the proportions of the hospitalization expenses of employee and resident medical insurance increased year by year in tertiary hospitals.The structural variation degree of total hospital expenses of all insured population was 13.89%,the variation degree of insured workers was 16.75%,and that of insured residents was 13.69%.The contribution rate of each structural variation in tertiary hospitals was the highest.The expenses paid by individual changed in negative way and other expenses changed in positive way in primary and secondary hospitals.Conclusions There is an obvious flowing trend of basic health insurance inpatients seeking medical treatment in higher level of hospitals,which result in a dramatic increase in total medical expenses.It is suggested that payment mode be reformed and improved so as to enhance the use efficiency of funds and to curb the irrational growth of medical expenses.

关 键 词：基本医保 住院费用 费用流向 结构变动度 医保政策 医保费用 

分 类 号：R197[医药卫生—卫生事业管理]