某专科医院住院患者按床日付费与按项目付费实际自负情况分析  

Analysis of a specialized hospital actual out-of-pocket costs for inpatients based on per diem and fee-for-service payments

作　　者：时钢 王晓红[2] Shi Gang;Wang Xiaohong(Administrative Office,Tianjin Anding Hospital,Tianjin 300074,China;Department of Finance,Tianjin Anding Hospital,Tianjin 300074,China)

机构地区：[1]天津市安定医院院长办公室,天津300074 [2]天津市安定医院财务物价科,天津300074

出　　处：《中国中西医结合急救杂志》2024年第4期469-472,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：天津市科协科技创新智库课题(2023078)。

摘　　要：目的分析住院患者按床日付费政策执行前后患者自负费用的变化情况,评价按床日付费政策执行的效果.方法通过医院信息系统(HIS)收集2021年1月1日至2023年12月31日某专科医院医保患者住院相关数据,根据医院床日付费政策的实行情况分为新政执行前按项目付费组(2021年1月1日至2022年9月30日)和新政执行后按床日付费组(2022年10月1日至2023年12月31日),分析新政策执行前后和不同参保类型个人自负率的变化.结果最终统计覆盖按项目付费个案数6479个[其中城市职工医保(城职医保4767个),城乡居民医保(城居医保)1712个]和按床日付费个案数7743个(其中城职医保5679个,城居医保2064个).与新政策执行前按项目付费组比较,新政策执行后部分患者在某些情况下无需自付任何费用,按床日付费组住院患者平均自负率由(18.04±12.18)%下降至(15.14±12.45)%,平均下降了2.90%;城职医保患者平均自负率由(15.65±9.77)%下降至(12.58±8.91)%,平均下降了3.07%;城居医保患者平均自负率由(24.72±15.34)%下降至(22.18±17.21)%,平均下降了2.54%.结论新政执行后定点医疗机构基本实现了合理控制医疗费用增长,提高了患者受益水平,降低了患者就医负担,也推进了定点医疗机构主动控制患者实际负担费用有效地降低.Objective To analyze the changes in patients'self funded expenses before and after the implementation of the bed day payment policy for hospitalized patients,evaluate the effectiveness of the bed day payment policy implementation.Methods Hospitalization data for insured patients at a specialized hospital were collected from January 1,2021 to December 31,2023,using the hospital information system(HIS).Based on the implementation of the hospital's bed day payment policy,the patients were divided into a pre-implementation pay-per-item group(January 1,2021 to September 30,2022)and a post-implementation pay-per-bed group(October 1,2022 to December 31,2023).The analysis focused on the changes in personal responsibility rate before and after the new policy and across different insurance types.Results The final statistics cover a total of 6479 pay-per-itemt cases[4767 with urban employee medical insurance(urban occupational medical insurance)and 1712 with urban and rural resident medical insurance(urban residential medical insurance)]and 7743 pay-per-bed cases(5679 with urban occupational medical insurance and 2064 with urban residential medical insurance).Compared with pre-implementation pay-per-item group,some patients did not need to pay any out of pocket expenses in certain situations after the implementation of the new policy,the average personal responsibility rate of hospitalized patients in the post-implementation pay-per-bed group decreased from(18.04±12.18)%to(15.14±12.45)%,with an average decrease of 2.90%;the average personal responsibility rate of urban employee medical insurance patients has decreased from(15.65±9.77)%to(12.58±8.91)%,with an average decrease of 3.07%.The average personal responsibility rate of urban residentia medical insurance patients decreased from(24.72±15.34)%to(22.18±17.21)%,with an average decrease of 2.54%.Conclusion After the implementation of the new policy,designated medical institutions have basically achieved reasonable control over the growth of medical expenses,improved

关 键 词：精神疾病 床日付费 住院费用 自负率 

分 类 号：R19[医药卫生—卫生事业管理]