天津某军队医院医保住院患者个人负担费用影响因素分析

目的分析住院参保患者个人负担费用增长情况,为医院有效控制个人负担费用提供依据。方法从天津某三级医院医院信息系统、城镇职工医疗保险管理信息系统中收集2008-2012年的住院人次、次均发生费用、次均申请支付费用、次均自费金额等数据进行统计分析。结果 2008-2012年该医院医保住院病人次均个人负担费用分别为4 236.79、4 426.59、4 667.95、4 792.27、5 032.90元,均占各年次均发生费用的三分之一左右;其中次均自费金额分别为1 256.31、1 381.05、1 562.82、1 771.03、1 960.08元。次均个人负担费用因现行地区医保支付标准、低效及无效住院日、部分药品费用较高、高新技术设备引进、患者自主控制费用意识薄弱等因素影响,呈逐年增长趋势。结论 2008-2012年该医院医保住院病人次均发生费用逐年增长,主要由于次均个人负担费用的增长所导致;次均个人负担比例的增长,主要体现在自费比例的增长。应采取综合措施,以降低住院患者个人负担费用。

INFLUENCING FACTOR OF PERSONAL EXPENSES PAID BY INSURED INPATIENTS IN A MILITARY HOSPITAL IN TIANJIN

Objective To analyze the growth in personal expenses paid by individual insured inpatient,so as to provide the basis for the hospital to effectively control these expenses. Methods The data of total number of inpatients per year,average total incurred cost per visit,average applied insurance payment per visit,average private expense（ not included in medical insurance） per visit etc in 2008- 2012 year were collected and analyzed from the Hospital Information System of a third grade hospital in Tianjin,and the Medical Insurance Management Information Systems for Urban Workers. Results From 2008 to 2012,the average personal expenses paid by insured inpatients per visit were ￥ 4236. 79,￥ 4426. 59,￥ 4667. 95,￥ 4792. 27,and ￥ 5032. 90 respectively,which accounted for about one third of the average total incurred cost per visit for each corresponding year; and among which,the average private expenses were ￥ 1256. 31、￥ 1381. 05、￥ 1562. 82、￥ 1771. 03、￥ 1960. 08 respectively for each corresponding year,indicating a clear increasing trend. The existing regional medical insurance payment standard,prolonged hospitalization,the introduction of high-tech equipment,high cost of some drugs,and weak awareness of self-cost control of the patient,etc were the influencing factors. Conclusion The average total incurred cost per visit from insured inpatients was increased year by year from 2008 to 2012,which is mainly due to the increased average personal expenses paid by the inpatients and this increase is reflected in the increased percentage of inpatient＇s private expenses component. It is essential to take measures to reduce the average personal expenses paid by insured inpatients.