基本医疗保险对单病种住院费用的影响

目的 通过对医保与非医保住院病人单病种住院费用的比较,探索医疗保险供、需、保三方及相关政策对单病种住院费用的影响,分析基本医疗保险的整体效率及经济效益,为控制医保住院费用过快增长提出相关对策,为实施单病种付费制提供科学依据方法收集广东省湛江市某三级甲等医院2006年5月至2008年6月83 607例出院病人的病案首页资料及住院费用资料,选取住院构成前10位的病种进行研究,最终选择其中基本医疗保险按病种支付费用的7个病种进行分析,采用参数检验与非参数检验的方法,对医保与非医保病人的单病种住院费用及医保支付标准进行比较结果 医保组与非医保组次均住院费用的横向比较发现,同一年度、同一病种,医保组病人的次均住院费用普遍高于非医保组,差异均有统计学意义（P〈0.05）;各病种医保组与非医保组次均住院费用的纵向比较发现,2组病人单病种次均住院费用均有逐年上涨的趋势,但医保组住院费用增长幅度有逐渐减小的趋势;各病种次均住院费用与基本医疗保险按病种支付定额标准进行比较,差异有统计学意义结论 基本医疗保险刺激了医疗需求,减缓了医疗费用的上涨趋势,对医院的经营管理影响较大,医院应加强各病种的成本核算,在保证医疗服务质量的前提下,优化服务流程,规范诊疗行为,提高服务效率,努力控制成本.

Effects of the basic medical insurance to the hospitalization expenses of single disease

Objective Through the comparison of the insured and uninsured inpatient hospitalization expenses of single disease, to explore the influencial factors that working on hospitalization expenses by the basic medical insurance, analyze the whole efficiency and economic benefits of medicare premium, and provide scientific guidance for controling hospitalization expen- ses and practicing the payment means which basing on Diagnosis Related Groups （DRGs）. Methods Collecting the first page of the medical record and expensing data of 83 607 inpatients during May 2006 and June 2008, study on seven single diseases during the top 10 disease of hospitalization composition which paid by disease entity in medicare. Applying the approaches of Para- metric Test and Nonparametric Test to compare hospitalization expenses and the medicare payment standard between insured and uninsured group. Results Horizontal comparison showed that the mean of hospital costs of insured group is generally higher than non-insured group in the same year to every single disease（ P〈0.05 ）. There has a rising trend in both group for every single dis- ease, but the amplitude gradually decrease in medicare group. The difference between the medicare payment standard and the mean of hospitalization costs is singuificant to every single disease . Conclusion The basic medical insurance is significant to hospital management which stimulate the medical demand, decrease the rising trend of hospitalization cost. Hospital should strengthen the disease cost accounting, optimize the process of service, practice standard diagonosis and treat behavior, improve service efficiency and control the cost under the premise of the quality of medical service.