军队医院医保自费比例构成与控制分析

目的 通过分析军队医院医保患者自费比例的构成,分析2011-2015年自费比例控制情况,同时与同级同类医院进行比较,拟通过控制自费比例,来控制整体医保费用.方法 通过某驻京部队医院HIS系统,以及北京医疗保险业务端组件查询系统,统计该医院2015年医保患者自费比例构成与2011-2015年自费比例增长趋势,并与同级同类医院进行横向比较.结果 导致自费比例较高的原因主要为药品、检查治疗和材料费用,2011年开始北京实行总额预付制度,2011-2015年该院将自费比例纳入绩效考核指标后,2011-2012年自费比例大幅下降,2012-2015年自费比例呈逐年平稳小幅上涨趋势,但增长幅度低于三级综合医院平均水平.结论 控制自费比例要从源头抓起,控制药品、检查治疗和材料费用的增长是重中之重,要避免重复的检查和治疗,同时更要关注材料费用的上涨,采取综合措施控制自费比例,控制整体医保费用支出,进而减轻患者经济负担.

Proportion of payment-at-one's-own-expense of the public medical service in military hospitals and cost control

Objective To analyze the composition and proportion of the payment-at-one's-own-expense of the public medical service for those eligible people who could have medical care in military hospitals.Since the introduction of proportion of the paymentat-one's-own-expense into the performance indexes,analyses were made on the cost control of the proportion of payment-at-one's-ownexpense from 2011 to 2015.At the same time,when it was compared with the hospitals of same level,total medical costs could be controlled through the control of the proportion of medical service with payment-at-one's-own-expense,so that military hospitals could better serve the patients who were eligible to public medical service.Methods With the help of the Health Information System (HIS) of a certain military hospital in Beijing and the Information Query System of the Medical Insurance Business Terminal in Beijing,the proportion of the payment-at-one's-own-expense of the public medical service in 2015 was analyzed.Then,the growing trend of the proportion of the payment-at-one's-own-expense of the medical service system from 2011 to 2015 was statistically analyzed,and this proportion was horizontally analyzed with that of the identical hospitals of thc same level.Results The main reasons for higher proportion were drugs,laboratory tests and treatment,and medical materials.With the implementation of "total sum payment system" from 2011,in Beijing,and with the introduction of the proportion of the payment-at-one's-own-expense of the medical service system into the performance indexes from 2011 to 2015,this proportion was considerably decreased from 2011 to 2012.However,from 2012 to 2015,this proportion was gradually increased year by year,with the growth rate being lower than that of the average level of tertiary comprehensive hospitals.Conclusion The problem on the control of the proportion of the payment-at-one's-own-expense of the public medical service should be tackled from the source,Strict control on the rising costs of drugs,laboratory tests and medical materials is the focus of all the urgent issues.Repeated laboratory tests and treatment should be avoided.At the same time,attention should be paid to the rising costs of medical materials.Therefore,comprehensive measures should be adopted to control the proportion of the payment-at-one's-own-expense and the payment of total medical costs as well,so that economic load on patients could be relieved.