合肥市２００９～２０１３年城镇职工不同级别医院分娩方式现状分析

目的：本文通过对2009～2013年合肥市城镇职工生育保险现状的资料分析，探讨不同级别医疗机构分娩方式的构成及其成本差异。方法根据医疗机构的不同级别对2009～2013年合肥市参保城镇职工剖宫产与阴道分娩的生育住院费用、分娩方式进行比较分析。结果三级医院剖宫产及阴道分娩的住院费用高于一级、二级医院，二级医院剖宫产率呈上升趋势。自愿要求剖宫产率在不同级别医院中均呈上升趋势。结论建议加强医疗机构监管力度，进一步完善生育保险补偿政策。剖宫产率升高主要是孕产妇自愿要求增多所致，严格把握剖宫产指征是降低剖宫产率的关键。

Analysis of delivery ways of urban workers in medical institutions of different levels in Hefei

Objective To explore the composition and costs difference of delivery ways in medical institutions of different levels, based on the analysis of current maternity insurance situation for urban workers in Hefei from 2009 to 2013.Methods The inpatient expend-itures between delivery ways of cesarean section and vaginal delivery in medical institutions of different levels for urban workers with maternity insurance were compared and analyzed.Results In tertiary hospitals,the inpatient expenditures of both delivery ways were higher than those in first hospitals and secondary hospitals,and the cesarean section rate in secondary hospitals was on the rise.Increasing pregnant women choosing cesarean delivery in medical institutions of different levels might account for this change.Conclusion It is important to strengthen supervision over medical institutions of different levels,and to improve the compensation mechanism of maternity insurance.Because the in-crease of cesarean rate is mainly due to inadequately widening of medical indications in some maternity clinics,so the key point to reduce ce-sarean rate lies in how to rightly holding indications of cesarean section.