城乡儿童不同支付方式住院医疗费用比较及其影响因素分析

目的比较参加城镇居民医疗保险（参保）和新型农村合作医疗（参合）患儿的住院医疗费用，分析不同支付方式医疗费用的影响因素，为完善覆盖城乡居民的医疗保障体系提供参考。方法选择唐山市滦县2011年度住院的0～14岁参保患儿（n=387）和参合住院患儿（n=3134），收集患儿的个体情况和临床资料，采用单因素和多元回归统计学方法分析住院医疗费用及不同支付方式医疗费用的影响因素。结果参保儿童平均住院费用为1632．12元，显著高于参合儿童的932．84元，差异有统计学意义（P〈0．05）。参保和参合患儿的药费分别占住院医疗费用的57．5％和59．8％；统筹支付费用分别占61．6％和59．5％，个人支付费用分别占38．4％和40．5％。个人因素（年龄、住院日、入院情况）和社会因素（医院级别、收入水平、医保类型）是患儿住院医疗费用及不同支付费用的共同影响因素。结论降低医疗费用主要应控制社会因素，逐步完善不同级别医院的统筹支付比例，以建立城乡统筹的全民医疗保障。

Comparison of hospitalization medical costs of different payment between urban and rural children and analysis of its influencing factors

Objective To compare hospitalization medical costs for children with urban resident medical insurance and new rural cooperative medical care, and to analyze the influence factors of different payments for medical costs so as to provide references for perfecting the medical security system of both urban and rural residents. Methods The hospitalization children of 0 ~ 14 years old with urban resident medical insurance （ n = 387） and new rural cooperative medical care （n =3 134） were chosen in 2011 in Luan County of Tangshan City. Their hospitalization medical costs and the influence factors of different payments for medical costs were analyzed by the univariate analysis and multivariate regression method. Results The average hospitalization medical cost for children with urban resident medical insurance was 1 632.12 Yuan, which was significantly higher than children with new rural cooperative medical care （932.84 Yuan）. The difference was statistically significant （P 〈 0.05）. For children with urban resident medical insurance and new rural cooperative medical care, the drug costs accounted for 57.5% and 59.8% of the hospitalization medical costs, of which the fund payments were 61.6% and 59.5%, while individual payments were 38.4% and 40.5% respectively. Both personal factors （age, hospitalization days, and conditions of entering hospital） and social factors （hospital grade, income level, and medical insurance type） were influencing factors, which affected the hospitalization medical costs and different payments for children with urban resident medical insurances and new rural cooperative medical care. Conclusion Reducing medical costs should be achieved mainly by controlling the social factors and gradually improve the proportion of fund payments in different grade hospitals to establish the consolidated medical insurances in urban and rural areas.