定额结算下医保定点医院费用补偿效果分析

目的分析定额结算下,各级医保定点医院费用补偿情况.方法通过对97所医保定点医院实际运行资料,采用数据挖掘和经济学分析方法进行.结果49.48%的医院年平均住院费用超过了其定额结算标准,合计补偿不足部分占实际费用发生额的9.50%,个别定点医院严重超定额.结论必须在加强对定点医院费用审核的同时,进一步完善定额结算方式,制定科学的定额结算标准.

Analyze of the Effect of the Expenditure Expiation for the Contract Hospitals Under the Flat Rate Payment System

Objective To analyze the effect of the expenditure expiation for different class contract hospitals under the flat rate payment mode.Method Data mining and economics method were used to analyze 97 contract hospitals practical running data.Results For 49.48% of contract hospitals,their annual average insured inpatient expenditure exceeded its flat rate standard.Insufficiency of expenditure expiation accounts for 9.5%of total outgoes.The annual average inpatient expenditure was seriously overrun in a few of contract hospitals.Conclusion It must be strengthened in auditing for contract hospitals while the flat rate payment is be consummated.