不同基本医疗保险乳腺癌患者住院费用及其保障效应比较研究

发布时间：2018-01-20 15:42

本文关键词： 乳腺癌住院费用补偿比城镇职工医疗保险城镇居民基本医疗保险新型农村合作医疗　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景改革开放30余年,社会经济飞速发展,医疗事业也取得了长足的进步。然而,“看病难,看病贵”的问题,在全国仍较为普遍。党中央、国务院高度重视医疗民生问题,逐步推进医疗卫生体制改革,建立医疗保障体系。1998年在全国范围普及实行城镇职工医疗保险制度(以下简称“城职保”),主要惠及城镇职工。2003年逐步推行新型农村合作医疗制度(以下简称“新农合”),主要关注农村居民的医疗保障。自2007年开始,逐步实行城镇居民基本医疗保险制度(以下简称“城居保”),主要保障城镇非从业居民。全民医保的框架(包含城镇职工、农民、城镇非从业人员)已经基本搭建完成。研究目的本文首先对蚌埠市三种基本医保制度进行了梳理；其后分析了某医院三种不同医保制度乳腺癌患者住院费用及其差异；最后比较了三种医保制度对乳腺癌患者住院费用补偿水平。研究为相关部门完善医保政策提供理论参考依据。研究方法以在2008年至2013年某三甲医院就诊的本地级市的城职保、城居保以及新农合三类医保乳腺癌患者为研究对象,提取患者住院费用的具体相关信息。分析三种不同医保患者住院费用的差别。本研究拟采用文献复习与定量调查的方法,查阅相关的政策资料以及统计数据,获取信息。资料的来源为2008-2013年蚌埠市及各县、区医保政策文件、医院住院患者的病例首页信息系统、费用信息系统、医院医保办费用信息系统主要结果1、城职保、城居保以及新农合三组中西药费所占比例均最高(48.9%-51.3%),大致为总费用的一半。其次分别为诊断费(12.1%～12.7%)、治疗费(11.6%～12.8%)、手术费(10.0%～10.4%)、麻醉费(4.1%～5.2%)、中药费、其他。2、住院总费用、诊断费、治疗费、西药费、中药费、麻醉费在三组间有差异,P值分别为：0.000、0.021、0.000、0.000、0.003、0.016。手术费在三组间无显著差异,P=0.148。其中住院总费用：城职保患者组(15781.6元)及城居保患者组(16474.2元)要显著高于新农合患者组(13606.2元)；其中治疗费：城职保患者组(1962.0元)及城居保患者组(2113.1元)要显著高于新农合患者组(1575.7元)；其中西药费：城职保患者组(8088.2元)及城居保患者组(8146.2元)要显著高于新农合患者组(6653.4元)。3、不同医保患者次均住院天数差异不大(F=1.702,P=0.183), 但日均住院费用差异明显(F=16.543,P=0.000),城职保组为1142.6元,城居保组为1111.0元,新农合组为953.6元。城职保日均住院费用最高,新农合日均住院费用最低。这可能与城市居民基本消费能力较高以及报销比例较高有关。4、从次均总费用来看,城职保、城居保与新农合分别为15781.6元、16474.2元、13606.2元,城居保略高于城职保,远高于新农合,差异有统计学意义(P=0.000)；从次均补偿来比较,新农合(6093.8元)最低、城居保(8730.8元)其次,城职保(11828.9元)最高,三者差异具有显著性(P=0.000)；从三类医保的次均个人支付来看,城居保(7743.4元)最高,新农合(7512.5元)其次,城职保(3952.6元)最低,三者差异具有统计学意义(P=0.000)；新农合实际补偿比44.8%,最低。城居保实际补偿比54.0%,居中。城职保实际补偿比75.0%,最高。三者具有显著性差异(P=0.000)。结论与建议1、医保部门及医疗机构应重点监控城职保及城居保住院费用支出,控制住院费用上涨的速度。医疗机构要继续优化住院费用结构,其中尤其要控制住院天数及药品比例。2、提高医务人员的劳务价值在住院费用的构成比。3、政府应加大新农合财政投入,扩大覆盖面,改革城居保及新农合医保支付模式,提高实际报销比例,于此同时进一步提高医疗服务质量,促进卫生服务公平性。4、加强医疗保险管理,探索研究多元化的缴付费模式。改进医疗保险服务,方便参保群众。
[Abstract]:On the background of 30 years of reform and opening up, the rapid development of social economy, medical industry has made considerable progress. However, the "difficult and expensive" problem in the country is still relatively common. The Party Central Committee, the State Council attaches great importance to the medical problems of people's livelihood, gradually advancing the reform of health system, the establishment of medical security system in China.1998 the scope of implementation of universal medical insurance system for urban employees (hereinafter referred to as the "city job security"), the main benefit of urban workers.2003 years of gradual implementation of the new rural cooperative medical system (NCMS), the main concern of rural residents medical security. Since the beginning of 2007, gradually implement the basic medical insurance system for urban residents (hereinafter referred to as "City home insurance"), mainly to protect the urban non employed residents. The framework of universal health insurance (including urban workers, farmers, urban non practitioners) have been built. Basic research purpose This paper summarizes three kinds of basic medical insurance system in Bengbu city; the subsequent analysis of a hospital in three different health care system for patients with breast cancer hospitalization expenses and difference; finally compares three kinds of medical insurance system on the cost of compensation level in patients with breast cancer. Research for the relevant departments to improve medical insurance policy to provide theoretical basis for the research methods. In 2008 to 2013 in a hospital from local level city job security, city habitat protection and new three kinds of Medicare breast cancer patients as the research object, the specific information related to the hospitalization expenses of patients with extraction. Analysis of three kinds of hospitalization expenses of different Medicare patients. This study adopted the methods of literature review and quantitative survey access to information, access to relevant policy information and statistical data. The data source for Bengbu city and county 2008-2013, district hospital inpatient medical insurance policy documents Case of home information system, cost information system, the main results of hospital medical insurance office information system costs 1, city job security, the city ranks three and the new rural cooperative medicine group had the highest proportion (48.9%-51.3%), roughly half of the total cost. Then the diagnosis fee (12.1% ~ 12.7%), the treatment fee (from 11.6% to 12.8%), surgery (10% ~ 10.4%), anesthetic fee (4.1% ~ 5.2%), Chinese medicine fees, other.2, the total cost of hospitalization, diagnosis, treatment costs, the cost of Western medicine, Chinese medicine fee, anesthetic fee has difference between the three groups, P values were: 0.000,0.021,0.000,0.000,0.003,0.016. surgery had no significant difference between the three groups, P=0.148. of which the total hospitalization expenses: city job security group (15781.6 yuan) and city home insurance group (16474.2 yuan) was significantly higher than that of NCMS patients (13606.2 yuan); the treatment fee: city job security group (1962 yuan) and city home insurance group (2113.1 yuan) to show Than that of NCMS patients (1575.7 yuan); the medicine charge: city job security group (8088.2 yuan) and city home insurance group (8146.2 yuan) was significantly higher than that of NCMS patients (6653.4 yuan) of.3, the average hospitalization days of patients with different medical insurance differences (F=1.702, P=0.183), but the average hospitalization expenses significant differences (F=16.543, P=0.000), the city job group for 1142.6 yuan, 1111 yuan in the city group, the NCMS group was 953.6 yuan. The average daily hospitalization cost highest city job security, the NCMS hospitalization cost lowest. This may be related to the basic consumption of city residents to higher and higher proportion of reimbursement from.4, total cost city view, job security, and the new city home insurance were 15781.6 yuan, 16474.2 yuan, 13606.2 yuan, the city ranks higher than Bao slightly city job security, far higher than the NCMS, the difference was statistically significant (P=0.000); the average compensation of NCMS (6093.8 yuan), the lowest in the city Paul (8730.8 yuan) Secondly, city job security (11828.9 yuan), three with significant difference (P=0.000); from three kinds of insurance are the individual payment, the city ranks highest (7743.4 yuan), the NCMS (7512.5 yuan) Secondly, city job security ($3952.6) minimum, statistically significant difference between the three groups (P=0.000); new actual compensation ratio of 44.8%, the city ranks the lowest. The actual compensation ratio of 54%, the city center. Job security the actual compensation ratio of 75%, the highest. Three significant differences (P=0.000). Conclusions and recommendations 1, health departments and medical institutions should focus on monitoring the city job security and city home insurance hospitalization expenses, hospitalization expenses control the rate of rise. Medical institutions should continue to optimize the structure of hospital costs, especially to control the length of hospitalization and drug ratio of.2, improve the medical staff's labor value in the form of hospital costs than.3, the government should increase financial investment in expanding the coverage of new rural cooperative medical system. Reform, city home insurance and new rural cooperative medical insurance payment mode, improve the actual reimbursement ratio, at the same time, to further improve the quality of medical services, and promote the.4 health service fairness, strengthen the management of medical insurance payment fees, explore the mode research diversified. The improvement of medical insurance services, the convenience of insured people.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R197.3;R737.9

【共引文献】