[1]黄 颖,殷泰平.新疆兵团医疗保险患者住院费用支付结构及影响因素分析[J].医学信息,2022,35(05):145-149.[doi:10.3969/j.issn.1006-1959.2022.05.038]
　HUANG Ying,YIN Tai-ping.Payment Structure and Influence of Hospitalization Expenses for Medical Insurance Patients in Xinjiang Production and Construction Corps[J].Medical Information,2022,35(05):145-149.[doi:10.3969/j.issn.1006-1959.2022.05.038]
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新疆兵团医疗保险患者住院费用支付结构及影响因素分析()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
35卷
期数:
2022年05期
页码:
145-149
栏目:
调查分析
出版日期:
2022-03-01

文章信息/Info

Title:
Payment Structure and Influence of Hospitalization Expenses for Medical Insurance Patients in Xinjiang Production and Construction Corps
文章编号:
1006-1959（2022）05-0145-05
作者:
黄 颖; 殷泰平
（1.石河子大学医学院预防医学系，新疆 石河子 832000；2.新疆生产建设兵团医疗保障局，新疆 乌鲁木齐 830000）
Author(s):
HUANG Ying; YIN Tai-ping
(1.Department of Preventive Medicine,School of Medicine,Shihezi University,Shihezi 832000,Xinjiang,China;2.Medical Security Bureau of Xinjiang Production and Construction Corps,Urumqi 830000,Xinjiang,China)
关键词:
住院费用; 支付结构; 医疗保险; 医疗机构等级
Keywords:
Hospitalization expenses; Payment structure; Medical insurance; Grade of medical institutions
分类号:
R197.1
DOI:
10.3969/j.issn.1006-1959.2022.05.038
文献标志码:
A
摘要:
目的 分析2018年新疆兵团医保患者住院费用及其支付结构，探索影响住院费用的各类因素，为缩控住院医疗费用，提高基金运行效率提供参考意见。方法 收集2018年1月-12月新疆兵团住院结算数据418 015例，描述分析住院费用分布及其支付结构。应用多重线性回归模型对住院费用的各影响因素进行分析。结果 2018年1月-12月兵团医保患者住院费用集中在10 000元以下，住院费用最高的医疗机构为三级医院，住院费用占比最高组成为诊疗项目费用；职工医保支付费用占住院费用的比例为69.01%，居民医保支付费用占住院费用的比例为62.67%，随着住院费用的增加，大病支付所占的比例逐渐增大，且职工医保大于居民医保；职工医保个人支付占住院总费用的比例为30.99%，居民医保支付占住院总费用的比例为37.33%。住院患者个人支付中自费金额占比远远低于自付金额医疗机构等级、医保支付比例、住院天数、诊疗费用、药品费用、服务设施费用、年龄及性别为住院费用的影响因素。结论 兵团医保待遇水平需进一步提高，特别是居民医疗保险。应加快落实分级诊疗政策，控制住院天数，加强群众的健康教育，提高群众的健康素养，以控制住院费用的增长，提高医保基金运行效率。
Abstract:
Objective To analyze the hospitalization cost and payment structure of Xinjiang Corps medical insurance patients in 2018, explore various factors affecting hospitalization cost, and provide reference opinions for reducing hospitalization cost and improving fund operation efficiency.Methods The settlement data of 418 015 inpatients in Xinjiang Corps in 2018 were collected, and the distribution and payment structure of inpatient expenses were described and analyzed. Multiple linear regression model was used to analyze the influencing factors of hospitalization expenses.Results From January to December 2018, the hospitalization expenses of medical insurance patients in Xinjiang Corps were concentrated below 10 000 yuan. The medical institutions with the highest hospitalization expenses were tertiary hospitals, and the highest proportion of hospitalization expenses was the cost of diagnosis and treatment projects. The proportion of workers’ medical insurance payment costs in hospitalization expenses was 69.01%, and the proportion of residents’ medical insurance payment costs in hospitalization expenses was 62.67%. With the increase of hospitalization expenses, the proportion of serious illness payment increased gradually, and workers’ medical insurance was greater than residents’ medical insurance. The personal payment of medical insurance for workers accounted for 30.99% of total hospitalization expenses, and the payment of medical insurance for residents accounted for 37.33% of total hospitalization expenses. The proportion of self-paid amount in the personal payment of hospitalized patients was far lower than that of self-paid amount. The medical institution level, the proportion of medical insurance payment, hospitalization days, medical expenses, drug expenses, service facilities expenses, age and gender were the influencing factors of hospitalization expenses.Conclusion The medical insurance treatment level of Xinjiang Corps needs to be further improved, especially the residents’ medical insurance. We should speed up the implementation of hierarchical diagnosis and treatment policy, control hospitalization days, strengthen the health education of the masses, improve the health literacy of the masses, in order to control the growth of hospitalization expenses and improve the efficiency of medical insurance fund operation.

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更新日期/Last Update: 1900-01-01