南方某城市不同医疗保险政策对医疗服务的影响分析

目的描述比较2003～2010年南方某市综合医保、住院医保、农民工医保和少儿医保政策下医疗服务的差异,探讨不同医保政策对医疗服务的影响,为医疗保险管理部门提供控制策略。方法从南方某市医保局获得2003～2010年该市医疗服务费用数据,把费用分成门诊、住院两部分,通过对各种医保类型患者的总费用（药品费用、诊疗费用）、人均费用（药品费用、诊疗费用）、均次费用（药品费用、诊疗费用）的比较,发现各医保类型的费用变化趋势和差异,分析不同参保类型对医疗服务的影响。结果不同医保患者的门诊费用、住院费用中的总费用（药品费用、诊疗费用）、人均费用（药品费用、诊疗费用）、均次费用（药品费用、诊疗费用）差异均有统计学意义,综合医保各项指标较高,农民工医保各项指标较低。结论综合医保的各项指标著高于其他类型,农民工医保各项指标较低。要注意控制综合医保的医疗费用,提高农民工医保的医疗服务水平。在门诊费用控制中要注意控制比例较高的药品费用。

The Effect of Different Medical Insurance Policy on Medical Service in a Southern City

Objectives To compare the medical service of comprehensive health insurance,inpatient medical insurance,Migrant workers medical insurance and Children＇s health insurance in a southern city form 2003 to 2010,and to explore the effects of different medical insurance policy on medical service,give control strategy to medical insurance management department.Methods Obtained data of medical service costs from 2003 to 2010 from the South City Health Bureau.The cost was divided into two parts-outpatient and inpatient,through the comparison of the total costs（drugs and treatment）,cost per capita（drug costs,medical costs）,cost per visit（drug costs,cost of treatment） of patients of various type of medical insurance,to find the change trends and the differences,and to analyze the effect of different medical insurance on medical consumption.Results Different medicare patients had significantly different outpatient expenses and hospitalization expenses in the total cost（cost of drugs,treatment cost）,cost per capita（drug costs,medical costs）,cost per visit（drug costs,medical costs）,and the comprehensive health insurance were higher,migrant workers medical insurance were lower indexes in every index.Conclusions The comprehensive health insurance were higher,migrant workers medical insurance were lower indexes in every index.Attention should be paid on the control of comprehensive health insurance medical expenses,and improving medical service level of migrant workers medical insurance.In the outpatient service cost control we should pay attention to control the higher proportion of drug costs.