基于某医院医保住诊人次及费用的调查分析

目的基于某医院医保住诊人次及费用的调查,探索医保基金管理的有效途径。方法抽调某医院医保管理中心2010至2012年度报表,统计住诊人次及费用,采用Logistic线性回归模型进行分析,比较医保住诊人次及费用的变化和趋势。结果2011医保年度医保住诊人次增幅39.6%,2012医保年度医保住诊人次增幅35.6%,年度增幅比较差异具有统计学意义(P<0.05),虽然增幅有所下降,但仍保持较高的增长幅度;2011医保住诊费用增幅50.9%,2012医保住诊费用增幅29.1%,年度增幅比较差异具有统计学意义(P<0.05),但其年增幅逐年有所下降,且下降幅度较大。结论医保基金管理存在的问题具有结构刚性的特点,树立共同管理医保基金的意识,提高基层医疗水平,实现医保管理信息化,引导老年居民合理使用医保基金,有利于防止滥用医保基金、浪费医疗资源。

Investigation on Medical Insurance Patients and Expenses in a Hospital

Objective To explore effective measures of medical insurance fund management based on the investigation of the number and expense of patients with medical insurance. Methods The number and expense of patients with medical insurance from 2010 to 2012 were statistically analyzed, to compare the changes and trends of the number and expense of patients with medical insurance. Results The number of the patients had increased by 39.6% in 2011 and by 35.6% in 2012. Although the annual amplification had decreased, it still maintained a high growth rate, with statistical significance （P〈0.05）. As for the expenses of the patients, it dropped by a big margin of 50.9%in 2011 and 29.1%in 2012, with statistical significance （P〈0.05）. Conclusions As for the problems of medical insurance fund management featured as structural rigidity, it is beneficial to prevent the abuse of the medical insurance fund and the waste of medical resources by establishing the sense of co-management of medical insurance fund, improving primary health care level, promoting application of information technology in medical insurance management, and guiding the senior citizens to rational use of medical insurance.