某三甲医院城乡居民2013年住院患者疾病构成及费用分析

目的 比较某三甲医院参加城镇居民医保(简称居民医保)和参加新型农村合作医疗(简称新农合)住院患者疾病构成及住院医疗费用,分析其现状和影响因素。方法 选择该医院2013年所有住院的城乡居民患者的病例资料,比较居民医保和新农合住院患者的疾病构成、科室分布、住院费用构成、医疗费用。结果 居民医保和新农合住院患者的疾病类型和科室分布各有特点;新农合患者平均住院总医疗费13855.25元、平均统筹支付费用6086.17元及平均个人支付费用7769.08元均较居民医保的11676.42元、5394.95元及6216.06元要高,差异均有统计学意义(P<0.05);药费、材料及其他费用均占两类患者总住院费用的70%。结论 居民医保患者住院费用较新农合患者低。降低住院费用要控制药费、材料和其他费用尤其高值耗材使用,完善城乡统一医疗保障、实施分级诊疗等综合措施。

Analysis of disease compositions and expenses of urban and rural inpatients in a tertiary hospital in 2013

ObjectiveTo compare the disease compositions and hospitalization expenses of inpatients participated in the medical insurance for urban residents(orresident medical insurance for short) or the new rural cooperative medical system(NRCMS) in a tertiary hospital, and to analyze its present situation and influence factors.Methods All case records of urban and rural inpatients admitted into the tertiary hospital in 2013 were collected, and the diseases compositions, department distribution, hospitalization expenditure breakdown and medical expenses payment of inpatients with resident medical insurance or NRCMS were compared.Results The inpatients covered by resident medical insurance or NRCMS displayed distinctive features in terms of disease type and department distribution.Compared with the patients covered by resident medical insurance, the NRCMS patients generally spentmuch higher on the average total hospitalization costs, average risk-pooling fund payment and average individual payment, with statistically significant differences(P<0.05).Drugs and materials expenses and other costs accounted for about 70% of the total hospitalization expenses in the two groups.Conclusion Patientswith residentmedical insurancehas lower hospitalization costs than thosewith NRCMS.To control the drugsand materials expensesand other costs, especially restrict the use of high value consumables, would reduce the hospitalization expenses.Othercomprehensive measuressuch as implementation of hierarchical medical system, improvement of unified urban and rural medical securitysystemare necessary.