城镇居民医疗保险参保患者住院费用支付结构及影响因素分析

目的 通过分析2017年山西省某市城镇居民医疗保险参保患者住院费用来反映目前医疗保险运行现状及可能存在的问题，提出相应管理建议及措施。方法 针对2017年山西省某市71032例城镇居民医疗保险参保住院患者分析其支付结构并运用多元逐步回归方法分析对参保患者的住院费用的影响因素。 结果 2017年山西省某市参加城镇居民医疗保险的患者住院费用5千元以下主要集中在0~9岁年龄段，且年龄越高高额住院费用出现比例越高；人次最多的住院费用段为0.5~1万元。年龄、性别、医疗机构等级、统筹支付、基本自付、大病自付分别是参保患者住院总费用的独立影响因素。其中住院总费用与基本自付比例成负相关，医疗机构等级对参保患者住院总费用影响最大。结论 参保患者医疗费用支出会随着年龄的增长而增加；参保患者住院总费用越高，基本自付比例越少，个人负担越少；需完善医疗机构分级诊疗制度，规范临床诊疗路径，减轻患者的经济负担。

Payment structure and influencing factors of hospitalization expenses for medical insurance of urban residents

To reflect the current status and possible problems of medical insurance operation by analyzing the hospitalization expenses of the insured patients in a certain city of Shanxi Province in 2017,and to put forward corresponding reform suggestions and measures. Methods A total of 71 032 urban residents’ medical insurance insured inpatients in a city of Shanxi Province in 2017 were used to analyze the payment structure. Multiple stepwise regression method was used to analyze the influencing factors of the insured inpatients’ hospitalization expenses.Results In 2017, the hospitalization cost of patients participating in urban residents’ medical insurance in a city in Shanxi Province was less than 5 000 yuan mainly concentrated in the 0-9 age group, and the higher the proportion of high hospitalization expenses at higher age, and the highest number of people were in the cost of 5 000-10 000 yuan. Age, sex, medical institution level, overall payment ratio, basic self-payment ratio and major illness self-payment ratio were independent effects of total hospitalization expenses.The proportion of basic self-payment was negatively correlated with the total hospitalization expenses, and the grade of medical institutions had the greatest influence on the total hospitalization expenses.Conclusion The medical expenses of insured patients will increase with the growth of age.The higher the total hospitalization expenses of insured patients, the less the basic out of pocket proportion and the less personal burden. It is necessary to improve the hierarchical diagnosis and treatment system of medical institutions, standardize the clinical diagnosis and treatment path, and reduce the economic burden of patients.