城乡居民医疗保险费用比较分析及其影响因素研究

发布时间：2018-11-01 18:33

【摘要】：目的从2003年以来，河北省先后建立了针对农村居民的新型农村合作医疗和针对城镇非从业居民的城镇居民基本医疗保险。但由于这两种医保政策管理程序、参保人群、保障待遇等多方面规定都不相同，导致城乡居民住院医疗费用间存在差距。本文对河北省某县城镇居民基本医疗保险和新型农村合作医疗的实施情况进行分析，在此基础上对两种不同医疗保险制度下，患者的住院医疗费用进行比较研究，深入了解住院费用的构成和影响因素，探讨导致住院医疗费用上涨的主要原因，进而提出控制住院医疗费用增长的控制措施，为完善城乡居民医疗保障制度提供参考。方法资料来源于河北省某县医疗保险中心、新农合管理系统，选取该县2011年1月到2011年12月31日本地住院的城镇居民医保患者和新农合患者，，作为研究对象。收集患者个人详细信息及住院费用的相关数据，将患者所有资料录入excel建立数据库，对患者人口学资料、住院费用基本情况和构成情况进行一般性统计描述，住院费用构成包括住院总费用、药费、治疗费、检查费、手术费、特检费和床位费，比较两种医疗保障制度下患者住院费用的差别；采用SPSS19.0统计软件对住院费用的影响因素进行单因素和多因素分析。主要采用的统计方法有Mann-Whitney U检验、 Kruskal-Willas H检验、多元逐步回归分析。结果1住院医疗费用构成中，城镇居民医保患者的药费、治疗费和检查费的构成比是53.76%、13.29%和9.91%；新农合患者的药费、治疗费和检查费为52.95%、15.86%和12.05%，分别排在两种医保患者住院费用的前三位。2住院医疗费用支付方式上，城镇居民医保患者个人支付比例12.54%，统筹支付比例87.46%；新农合患者个人支付比例和统筹支付比例分别为33.60%和66.40%。3城镇居民医保患者和新农合患者住院费用比较：城镇居民医保患者的平均住院费用（2069.77元）高于新农合患者平均住院费用（1936.11元）；城镇居民医保患者的药费、检查费、特检费和手术费均高于新农合患者，差别有统计学意义（P＜0.05）。4城镇居民医保患者住院费用的影响因素有年龄、住院天数、有无手术和医院级别。患者年龄越大，住院时间越长，住院费用越高；进行手术和大型检查项目使得患者住院费用增高；就诊于二级医院的患者住院费用高于基层一级医院。5新农合患者住院费用的影响因素为性别、年龄、住院天数、有无大型检查、有无手术和医院级别。男性患者住院费用明显高于女性患者；住院时间越长，患者住院费用越多；不同年龄组的患者间住院医疗费用有差异，差别具有统计学意义（P＜0.05）；手术患者住院费用高于非手术患者；就诊于二级医院患者住院费用高于一级医院患者。结论1不同医疗保障制度下，城镇居民医保患者的住院费用高于新农合患者。2新农合统筹基金补偿水平低于城镇居民医保，有待进一步提高。3根据病情选择就诊医院，在明确诊断的前提下，严格掌握用药指征和手术适应症，降低住院天数，减少药费比重，能减少住院费用，减轻患者个人及统筹基金支付压力。
[Abstract]:Objective Since 2003, Hebei province has established a new rural cooperative medical system for rural residents and basic medical insurance for urban residents of non-residents in cities and towns. However, because these two kinds of health insurance policy management procedures, the insured people, the safeguard treatment and so on various regulations are different, resulting in the gap between the medical expenses between the urban and rural residents. This paper analyzes the implementation of the basic medical insurance and the new rural cooperative medical system in a county of Hebei Province. On the basis of this, the medical expenses of the patients are compared and studied in two different medical insurance systems, and the composition and influencing factors of hospitalization expenses are deeply understood. This paper discusses the main causes of the increase in hospital medical expenses, and then puts forward the control measures to control the increase of hospital medical expenses and provides reference for perfecting the medical insurance system of urban and rural residents. Methods From January 2011 to December 31, 2011, the medical insurance center and Xinong Joint Management System of a county in Hebei Province were selected. Object: Collect relevant data of patient's personal details and hospitalization expenses, input all the data in the patient to excel to establish a database, make general statistical description of patient demographic data, basic conditions and composition of hospitalization expenses, including total hospitalization expense, medical expense, treatment The difference of hospitalization expenses of patients under the two medical security systems was compared with the treatment fee, examination fee, operating fee, special examination fee and bed position fee. The factors influencing the hospitalization cost were single factor and multi-factor. Analysis. The main statistical methods were Mann-Whitney U test, Kruskal-Willas H test, multivariate stepwise regression. Results 1 The composition ratio of medical expenses, treatment fee and examination fee for medical insurance patients of urban residents was 53. 76%, 13. 29% and 9. 91%. The medical expenses, treatment cost and examination fee of Xinong patients were 52. 95%, 15. 86% and 1. 2. 05%, in the first three of the two medical insurance patients' hospitalization expenses. In the way of hospital medical expenses payment, the proportion of personal payment of urban residents' medical insurance patients was 12.54%, and the proportion of total payment was 8. 7. 46%; the proportion of individual payment and the overall payment proportion of the new farmers are 33. 60% and 66. 40%, respectively. The average hospitalization expenses of urban residents' medical insurance patients (2069. 77 yuan) are higher than the average hospitalization expenses of new farmers (1936). (11) The medical expenses, examination fee, special inspection fee and operating expenses of medical insurance patients of urban residents were higher than those of new farmers. The difference was statistically significant (P <0.05). The influencing factors of hospitalization expenses for urban residents of urban residents were age, number of hospitalization days, and operation. The higher the patient's age, the longer the hospital stay, the higher the hospitalization cost, the higher hospitalization cost of patients who underwent surgery and large-scale examination, the hospitalization cost of patients with secondary hospitals was higher than that of the primary-level hospital. Sex, age, number of days in hospital, presence or absence of large-scale examination, presence or absence of surgery The hospitalization cost of male patients was significantly higher than that in female patients, the longer the hospitalization time, the higher the hospitalization cost of patients, the difference in hospitalization expenses among patients with different age groups, the difference was statistically significant (P <0.05). Non-surgical patients; hospitalization expenses for patients with secondary hospital higher than 1 Conclusion 1 In different medical security systems, the cost of hospitalization for urban residents in medical insurance is higher than that of new farmers. The compensation level of new non-agricultural integrated fund is lower than that of urban residents, which needs to be further improved. Under the precondition of definite diagnosis, strictly master the medication finger sign and surgical indication, reduce the number of hospitalization days, reduce the specific gravity of medical expenses, reduce hospitalization expenses, reduce the patient's personal and
【学位授予单位】：河北联合大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.1;F842.684

【参考文献】