基于大病病种分类的医药费用特征分析

目的：在界定大病病种的基础上对大病医药费用特征进行分析，提出我国大病保险政策落实和工作开展的相关建议，推进我国大病保障体系的建立与完善。方法：利用北京等6省（市）68家三级医院5036296份住院患者病案首页数据，分析大病病种范围及其单病种次均费用、总费用和费用构成。结果：60种重大疾病的平均住院费用超全国平均住院费用3倍，重大疾病费用负担占住院患者全病种费用负担的1／3以上，且药品是其高额费用产生的主要因素。结论与建议：探索按病种开展大病保险地区将60种疾病作为优先选择，强化服务要素准入管理、加强医疗服务行为监管、建立医疗机构内部激励约束机制以及综合支付方式改革等措施，建立保障与控费并行的大病保险监管和运行机制，提高大病保险经费的使用效率。

Analysis on characteristics of medical expenses based on catastrophic disease classification

Objective： In this paper, we analyze the characteristics of patient medical expenses for 60 cata- strophic diseases and propose recommendation to establish catastrophic disease insurance system. Methods：We col- lected 5036296 inpatient medical records from 2008 to 2009. The records were from 68 tertiary hospitals in six prov- inces. We calculated the average cost per visit for the patient, the total cost to the patient of treating the disease, and the breakdown of these costs. Results：The average cost to the patient per visit for these diseases was three times the national average cost to the patient per visit, the cost of treating the 60 catastrophic diseases accounted for one third of the cost of treating all diseases, and the cost of drugs is an important part of the high cost of treating catastrophic dis- eases. Conclusions and suggestions ： Such diseases could be prioritized in the establishment of catastrophic disease in- surance. It is important to establish systems for implementing and managing catastrophic disease insurance. This in- volves better managing access to health services, strengthening health services supervision, developing internal incen- tive mechanisms in medical institutions, reforming payment mechanisms, and promoting efficient use of catastrophic disease insurance funds.