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目的:对医保与非医保患者住院费用的影响因素进行分析比较,为相关部门制定合理有效的费用监督和控制措施提供依据。方法:选择徐州市中心医院2013年1月至2015年12月收治的医保病例1482例、非医保病例1176例,分析两类患者的费用分布及其影响因素。结果:医保患者的住院天数显著高于非医保患者,除泌尿系结石疾病外,其他3种疾病的医保患者住院费用和各项目支出均显著高于非医保患者。药费和治疗费是住院费用的主要支出项目,影响医保患者住院费用的主要因素依次包括住院天数、病种、入院时情况、合并症情况、是否手术、是否一级护理、是否医院感染、是否抢救以及并发症情况,影响非医保患者住院费用的因素依次包括住院天数、病种、合并症情况、是否手术、是否抢救以及并发症情况。结论:医疗保险制度未有效控制医疗费用上涨。我国医疗卫生体制改革需要重点调整医疗费用的构成,降低药费的比重。需要建立正确的科学的激励医院和医务人员的奖惩机制和合理的薪酬体系。
OBJECTIVE: To analyze and compare the influencing factors of hospitalization expenses between medical insurance and non-medical insurance, and provide the basis for relevant departments to formulate reasonable and effective cost supervision and control measures. Methods: 1482 cases of medical insurance and 1176 cases of non-medical insurance were collected from Central Hospital of Xuzhou from January 2013 to December 2015. The cost distribution and its influencing factors were analyzed. Results: The hospitalization days of Medicare patients were significantly higher than that of non-Medicare patients. Except for urolithiasis, the hospitalization expenses and other items of medical insurance for the other three diseases were significantly higher than those for non-Medicare patients. Medicines and treatment costs are the main expenses for hospitalization. The main factors that affect the hospitalization expenses of Medicare patients include the number of days of hospitalization, disease type, condition at admission, complications, whether surgery, primary care, whether hospital infection, whether The factors that affect the hospitalization expenses of non-Medicare patients include rescuing days, diseases, complications, whether surgery, whether to rescue, and complications. Conclusion: The medical insurance system does not effectively control medical costs. China’s medical and health system reform needs to focus on adjusting the composition of medical costs, reduce the proportion of drugs. Need to establish the correct scientific incentives hospitals and medical staff reward and punishment mechanism and a reasonable salary system.