目的了解天津市医保肝硬化住院患者个人支付和统筹支付费用的影响因素,探索降低住院费用的策略,为建立有效的费用控制机制提供依据。方法从天津市2003～2007年医保住院患者资料库中抽取肝硬化患者2341例,对其住院费用中的个人支付和统筹支付构成情况进行分析。组间比较采用秩和检验,用多元逐步回归方法对不同支付方式的影响因素进行分析。结果影响两种支付方式费用的主要因素均有住院天数,医院类别和治疗方式,人员类别还影响个人支付费用。住院日越长,医院级别越高,手术治疗患者个人支付和统筹支付费用越高,在职人员个人支付费用高于退休人员。结论政府、医院和医保机构各方面需协同努力,统一的诊疗常规基础之上考虑年龄、病情、治疗方式等因素而制定肝硬化的单病种收费标准,可以有效地降低肝硬化患者的个人及统筹支付费用。 Objective To understand the influencing factors of personal payment and co-ordinate payment for inpatients with Medicare-cirrhosis in Tianjin and explore strategies to reduce hospitalization costs, so as to provide basis for establishing effective cost control mechanism. Methods Totally 2341 patients with cirrhosis were enrolled from the database of inpatient medical insurance in Tianjin from 2003 to 2007, and the individual payment and co-ordination payment in hospitalization expenses were analyzed. Ranks test was used to compare between groups, and the influencing factors of different payment methods were analyzed by multivariate stepwise regression. Results The main factors affecting the cost of the two payment methods were length of stay, type of hospital and treatment, and the type of personnel also affected individual payment. The longer the hospitalization day, the higher the hospital level, the higher the cost of personal payment and co-ordination payment for patients undergoing surgery, and the higher the incumbents’ individual payment costs than the retirees. Conclusions The government, hospitals and medical insurance agencies need to work together in all aspects to formulate the charging standard for single disease of cirrhosis taking into account the age, condition and treatment methods on the basis of unified diagnosis and treatment, which can effectively reduce the individual and Co-ordinate payment of fees.