徐州市县域内居民医保参保患者的住院病种及费用分析  

Analysis of Inpatient Disease Types and Expenses of Insured Patients in Counties of Xuzhou

作　　者：陈礼江 唐静 黄广振 杨义森 关雪凌 覃朝晖 

机构地区：[1]徐州医科大学管理学院,徐州221004 [2]盐城市疾病预防控制中心办公室,盐城224001 [3]徐州市医疗保障局,徐州221006 [4]徐州医科大学医疗卫生应急救援研究中心,徐州221004

出　　处：《中国医疗保险》2022年第10期78-83,共6页China Health Insurance

基　　金：江苏省社会科学基金项目资助(20GLB006);江苏高校哲学社会科学研究重大项目资助(2021SJZDA136)。

摘　　要：目的:分析2018年—2019年徐州市县域内居民医保的参保患者在市、县两级医院的主要住院病种分布、住院费用及报销情况、住院费用的影响因素,为居民医保报销政策提供优化建议。方法:采用典型抽样方法,抽取徐州市4所医院2018年—2019年县域内居民医保参保患者。运用描述性研究和多因素二分类Logistic回归法,分析住院病种分布、住院费用及报销情况、住院费用的影响因素。结果:2018年和2019年县域内参保患者在县级医院住院148272人次,市级医院住院229476人次。县级医院的主要住院病种为呼吸系统疾病和循环系统疾病,市级医院为恶性肿瘤。市级医院住院患者的政策报销比低于县级医院。结论:建议完善双向转诊制度,结合医保差异化报销政策,建立基层住院病种目录,拓宽医保筹资渠道,降低患者再次住院起付线。Objective: The paper analyzes the distribution of main inpatient diseases, hospitalization expenses and reimbursement of insured residents’ in Xuzhou county hospitals from 2018 to 2019, so as to provide suggestions for reimbursement of residents’ medical insurance. Methods: A typical sampling method was used to select county residents with basic medical insurance from four hospitals in Xuzhou from 2018 to 2019. Descriptive research and multivariate binary logistic regression were used to analyze the distribution of inpatient diseases, hospitalization expenses, reimbursement status and influencing factors of hospitalization expenses. Results: From 2018 to 2019,148272 patients were hospitalized in county hospitals and 229476 patients were hospitalized in municipal hospitals.Respiratory and circulatory diseases were the main inpatient disease in county hospitals, while malignant tumors were the main inpatient disease in municipal hospitals. The policy reimbursement ratio of inpatients in municipal hospitals is lower than that of county-level hospitals. Conclusion: It is recommended to improve the two-way referral system, establish a catalogue of primary inpatients in combination with the differentiated reimbursement policy of medical insurance, broaden the financing channels of medical insurance, and reduce the deductible for rehospitalization of patients.

关 键 词：居民医保 病种分布 住院费用 报销比 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]