沈阳市城镇职工基本医疗保险个人账户使用情况调查

发布时间：2018-03-15 16:49

本文选题：城镇职工基本医疗保险　切入点：个人账户　出处：《沈阳医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的本研究了解沈阳市城镇职工基本医疗保险个人账户在门诊、住院、药房的利用情况以及参保职工对个人账户的认知、态度和建议,以期为政府和医疗保险管理部门制定个人账户的改革政策提供参考资料。方法个人账户在门诊、住院和药房的利用情况的数据来自于沈阳市医疗保险机构2008-2011年数据库;药房2012年第一季度的调查采用整群抽样的方式抽取360家药房;参保职工对个人账户认知的调查采用多级分层抽样的方法抽取参保职工7530人。数据分析采用动态数列、描述性统计分析、χ2检验等,并用Excel 2007和SPSS 22.0实现。结果1.个人账户余额:(1)2008-2011年个人账户余额和人均个人账户余额逐年增长。2009-2011年个人账户余额同比增长率分别为35.05%,24.45%和21.54%;人均个人账户余额同比增长率为24.75%、29.15%、28.04%。(2)女性参保职工个人账户余额和人均个人账户余额均少于男性;随年龄的增长,个人账户余额和人均个人账户余额均呈"菱形"分布;国家机关单位账户余额相对最少,但人均个人账户余额相对最多,企业单位则相反;年龄大于45岁的人均账户余额高于年龄小于45岁的;退休职工中,61-70岁的人均个人账户余额和结余率最高,50岁及以上的退休职工账户余额和结余率最低。2.个人账户在门诊、住院、药房支付情况:药房支出比例最高,住院支出比例最低,门诊和住院支出比例均呈逐年上升的趋势,药房支出比例逐年下降。3.药房2012年第一季度调查:357家药房的销售总额为30487.8万元,医保卡的销售总额为18507.35万元,后者占前者的60.70%;医保卡销售额中,用于药品的金额为销售总额的78.61%,其中处方药占46.86%,非处方药占53.14%;用于医疗器械的金额为销售总额的12.09%,其他则占9.3%。4.参保职工的调查:(1)认知情况:参保职工对个人账户划拨比例了解的比例为46.07%,且不同性别、年龄段、学历和地区之间差异显著;对其缴纳门槛费、缴纳自付费用、累计并计息和可以继承知道的比例分别为40.98%、46.51%、28.12%和26.63%,且郊区高于市区。(2)参保职工在医院经常使用个人账户的比例占44.52%,在药房经常使用的比例为62.41%。(3)从总体上看,认为在医院医保卡方便的比例为54.82%,现金方便的比例为20.32%。(4)调查对象中,有41.98%的参保职工关注个人账户余额;13.72%的人会去套现。(5)调查对象中,建议完全取消个人账户的人数占6.6%,49.01%的人不赞同个人账户的支付指定定点医疗机构。结论沈阳市城镇职工基本医疗保险个人账户余额呈逐年递增趋势;个人账户在门诊、住院的利用金额逐年增加,在药房的利用金额逐年减少,但在药房的利用率最高;沈阳市参保职工对个人账户的认知率、使用率及关注度均较低;取消个人账户不可取,应进一步加大个人账户的支付范围,不仅限于指定定点医疗机构。
[Abstract]:The purpose of this study is to understand the personal account of Shenyang city basic medical insurance for urban workers in the outpatient clinic, hospital, pharmacy and the insured workers personal accounts of cognition, attitude and suggestions, in order to develop personal accounts for the government and the medical insurance management department of the reform policies provide reference. Methods of personal accounts in the outpatient, hospital and pharmacy the use of the data from the Shenyang municipal medical insurance institution 2008-2011 years survey database; in the first quarter of 2012, the 360 pharmacy pharmacy from cluster sampling method; investigation of individual account insured workers by cognitive method of multi-stage stratified sampling of insured workers 7530 people. Data were analyzed by using dynamic data, descriptive statistical analysis, chi square the 2 test, and using Excel 2007 and SPSS 22. Results of the 1. personal account balance: (1) 2008-2011 years of personal account balance and personal accounts are Household balance increased year by year.2009-2011 years of personal account balance growth rates were 35.05%, 24.45% and 21.54%; the per capita personal account balance year-on-year growth rate of 24.75%, 29.15%, 28.04%. (2) personal account balance of female insured workers and per capita personal account balance is less than men; with the increase of age, individual account balances and per capita personal account balance showed a "diamond" distribution; state organs and units of account balance is the least, but the per capita personal account balance is relatively the most enterprises opposite; older than 45 years old was higher than the account balance per capita than 45 years old; retired workers, 61-70 per capita personal account balance and the balance of the highest rate, 50 years old and above the retirement account balances and balances the lowest rate of.2. personal accounts in the outpatient clinic, hospital, pharmacy case payment: Pharmacy expenditure ratio is the highest, the lowest proportion of hospitalization expenditure, outpatient and inpatient branch Out of proportion showed a rising trend year by year, the pharmacy expenditure ratio decreased year by year.3. pharmacy survey: the first quarter of 2012 total sales of 357 pharmacies was 304 million 878 thousand yuan, the total sales of health insurance card is 185 million 73 thousand and 500 yuan, which accounted for 60.70% of the former; Medicare card sales, used in medicine for the amount of 78.61% of total sales, including prescription drugs non prescription drugs accounted for 46.86%, accounting for 53.14%; for medical devices for the amount of total sales accounted for 12.09%, other 9.3%.4. employees: (1) cognitive: insured workers on personal accounts allocated proportion solution ratio is 46.07%, and the different gender, age, educational background and significant differences between the area of; pay pay fees threshold, cost, and interest can be inherited and accumulated know the proportions were 40.98%, 46.51%, 28.12% and 26.63% higher than that of urban and suburb. (2) the insured workers in hospitals often use a The account of the proportion of 44.52%, often used in the pharmacy of the ratio of 62.41%. (3) on the whole, that the hospital medical insurance card is convenient for the proportion is 54.82%, the proportion of cash for 20.32%. (4) survey, 41.98% of the insured workers pay attention to individual account balances; 13.72% people will go to cash. (5) survey, the number of proposals completely abolished personal accounts accounted for 6.6%, 49.01% of people do not agree with the personal account payment of designated medical institutions. The conclusion of Shenyang city urban workers' basic medical insurance personal account balance is increasing year by year; personal accounts in the outpatient clinic, the amount of hospitalization increased year by year, the amount decreased year by year in but in the pharmacy pharmacy, the highest utilization rate; the insured workers in Shenyang on the personal account of the cognitive rate, utilization rate and the degree of concern is lower; the abolition of personal accounts is not desirable, should further increase the personal account payment The scope is not limited to designated designated medical institutions.

【学位授予单位】：沈阳医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684

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