摘要
目的:在异地就医越来越便捷的背景下,分析保定市2023年异地(除京津冀地区外)就医住院患者就医地选择及医疗总费用影响因素,针对保定市异地就医基本情况和由此带来的医保基金监管挑战,提出相对应的意见和建议。方法:本研究首先运用Excel对保定市2023年异地就医住院患者的结算数据进行整理分析,建立数据库。其次利用SPSS 23.0软件对数据进行描述性统计分析、无序多分类logistics回归分析和多元线性回归分析。结果:保定市2023年异地就医参保人大多流向山东省(50.2%),总发生费用、基金支出总额平均值分别是17728.81元和10053.80元。无序多分类logistic回归分析显示:住院床日、医院等级、基金支付比例、年龄和人员类别是发生异地就医行为的显著影响因素(P<0.05)。多元线性回归结果显示:年龄、人员类别、住院床日、基金支出总额和基金支付比例是异地住院总费用的显著影响因素(P<0.05)。结论:保定市作为异地就医人次较多的参保地,应当健全当地基本医疗资源体系,合理引导和改善异地就医行为,完善异地基金监管机制,维护基金安全运行。
Objective:Under the background of increasingly convenient trans-provincial medical treatment,the paper analyzes the factors influencing the choice of trans-provincial(except Beijing City,Tianjin City and Hebei Province)medical treatment place and total medical cost in Baoding City in 2023,and puts forward suggestions according to the basic situation of trans-provincial medical treatment in Baoding City and the challenges of medical insurance fund supervision.Methods:Firstly,the paper used Excel to analyze the settlement data of Baoding City in 2023 for medical treatment in a different place and establish a database.Secondly,SPSS23.0 software was used to analyze the data by descriptive statistical analysis,unordered multicategorical logistics regression analysis and multiple linear regression.Results:Most of the insured people in Baoding City in 2023 who sought medical treatment in other places flowed to Shandong Province(50.2%),and the average values of total incurred costs and total fund expenditures were 17728.81 yuan and 10053.80 yuan,respectively.Unordered multicategorical logistics regression analysis showed that hospitalization bed days,hospital grade,fund payment ratio,age and personnel category were the significant influencing factors for the occurrence of off-site medical care behavior(P<0.05).The results of multiple linear regression showed that age,personnel category,hospitalization bed days,total fund expenditure and fund payment ratio were significant influencing factors of total costs of off-site hospitalization(P<0.05).Conclusion:Baoding City,as a place of insurance with a large number of medical treatment in other places,should improve the basic medical resources,reasonably guide and improve the behavior of medical treatment in other places,improve the supervision mechanism of the fund in other places,and maintain the safe operation of the fund.
出处
《中国医疗保险》
2025年第5期71-77,共7页
China Health Insurance
基金
2024年河北省医疗保障研究课题“基于保定市异地就医现状的医保基金监管问题研究”(JYB240206)。
关键词
异地就医
医保基金监管
LOGISTIC回归模型
trans-provincial medical treatment
medical insurance fund supervision
logistic regression model
