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目的:分析潍坊市2009—2013年度新型农村合作医疗住院病人住院费用结构变化情况,把握新型农村合作医疗住院病人费用流向和基金流向,为构建合理诊疗秩序、控制参保人群医疗总费用过快增长以及提高新型农村合作医疗基金使用效益提供依据。方法:采用结构变动度、结构变动值和结构变动贡献率等指标,从住院总费用及其分项目两个层面进行统计分析。结果:2009—2013年,一级医疗机构住院费用占比呈逐年下降趋势,二、三级医疗机构住院费用占比呈总体上升趋势。住院总费用结构变动度为21.46%,分项目结构变动度为40.48%。二级医疗机构各项目结构变动贡献率最高,累计达59.73%。一级医疗机构各项目呈负向变动,二级医疗机构个人自负呈负向变动,其余项目呈正向变动。结论:新型农村合作医疗住院病人有向更高级别医院流动的趋势,新型农村合作医疗筹资水平提高与医疗总费用大幅度上涨并存,建议通过医改政策合力来促进分级诊疗,限制医疗费用的过度上涨。
OBJECTIVE: To analyze the change of inpatient cost structure of inpatients in new rural cooperative medical care in Weifang in 2009-2013, to grasp the flow of hospitalization expenses and fund flow of new rural cooperative medical inpatients, to control the excessive growth of total medical costs for insured populations in order to establish a reasonable order of medical treatment and treatment And to improve the use of new rural cooperative medical fund to provide the basis. Methods: Using the indicators of structural change, structural change and the contribution rate of structural changes, the statistical analysis was carried out from the two aspects of total hospitalization expenses and its sub-projects. Results: From 2009 to 2013, the proportion of hospitalization expenses in primary medical institutions showed a decreasing trend year by year. The proportion of hospitalization expenses in secondary and tertiary medical institutions showed an overall upward trend. The total cost of hospitalization structural changes of 21.46%, sub-project structure changes of 40.48%. The contribution rate of the changes in the structure of the two medical institutions was the highest, accounting for 59.73% of the total. Each level of medical institutions showed a negative change in each project, while those in secondary medical institutions showed a negative change on their own initiative and the rest of the projects showed a positive change. Conclusions: Inpatients of new-type rural cooperative medical services have the tendency to move to higher-level hospitals. The raising of new-type rural cooperative medical care and the substantial increase of total medical costs coexist. It is suggested that medical treatment reform should be combined to promote graduation treatment and limit the excessive increase of medical expenses .