金杨社区养老机构医护人员现状及对影响医养融合因素的调查分析*

目的探索异地医保直接结算住院费用与本市城镇职工医疗保险住院费用的差异以及对异地医保总费用影响较大的因素。方法使用倾向评分匹配法等方法选取案例医院2018年度异地医保直接结算及本市职工医保两组费用数据各120例,使用t检验的方法比较两组数据的差异,使用多元线性回归的方法寻找对总费用影响较大的细分费用。结果 t检验结果表明,异地医保住院直接结算费用有7个细分项目,显著多于本市医保住院的相应费用,多元线性回归分析结果显示,异地医保的医保支付细分项目中,手术费、其他材料费、治疗费、检查费和其他费用这5项对总费用有着较为明显的影响。结论应在分析异地医保直接结算费用较高原因的基础上,以影响较大的细分费用为切入口,设法开展多项医保费用管理措施。

Analysis on the Hospitalization Expenses of Direct Settlement of Medical Insurance in a Tertiary Specialized Hospital

OBJECTIVE To explore the difference between the Inter-Provincial Direct Settlement of Medical Insurance(IPDSMI) and the hospitalization expenses of medical insurance for employees in Shanghai, and the factors that had great influence on the total expenses of IPDSMI. METHODS 120 cases of IPDSMI in sample hospitals in 2018 and 120 cases of medical insurance for employees in target city were selected by the method of propensity score matching. The differences between these two groups of data were compared by ttest. The method of multiple linear regression was used to find out the subdivision cost which had great influence on the total cost. RESULTS The results of t-test showed that there were 7 subdivisions of IPDSMI, which were significantly higher than the corresponding expenses of medical insurance in Shanghai. The results of multiple linear regression analysis showed that among the subdivisions of IPDSMI, there were 5 subdivisions as operation expenses, other materials expenses, treatment expenses, inspection expenses and other expenses which had a more obvious impact to total expense. CONCLUSION Based on the analysis of the reason why the IPDSMI cost higher, it should take the more influential subdivision costs as the entry point, and try to carry out a number of medical insurance cost management measures.