摘要
目的:对多层次医疗保障体系下四川省本级医保康复患者住院费用及医保报销情况的变化进行分析,为有效控制康复科患者住院费用、推进医保支付改革提供参考和数据支持。方法:选取四川省本级2018~2021年的康复患者作为研究对象,收集其住院费用以及医保结算信息,根据住院天数将患者分组。利用新灰色关联分析法和结构变动分析对康复患者住院费用及医保报销数据进行定量分析。结果:2018~2021年,治疗费是次均住院费用中构成比和关联度最大的影响因素,其次是药品费;结构变动贡献率前3位的费用是药品费、治疗费、检查费;药品费和床位费呈现负向贡献变动;住院天数≥60d组有其特殊性,其材料费是次均住院费用中构成比和关联度中影响较大的因素。补充层报销金额是次均住院费用报销中构成比和关联度中影响最大的因素;康复病人个负担持续加重。结论:多层次医疗保障体系下康复患者负担仍较重,商业健康险应着力保障长期住院康复患者。康复费用结构仍待优化,需警惕检查、耗材费用的上涨。下一步应持续探索兼顾学科特性、同时保障重点学科发展动力的康复适宜医保支付方式。
Objective To analyze the changes in the hospitalization expenses and reimbursement of medical insurance of rehabilitation patients at the provincial level under the multi-level medical security system in Sichuan Province,so as to provide reference and data support for effectively controlling the hospitalization expenses of rehabilitation patients and promoting the reform of medical insurance payment.Methods The rehabilitation patients in Sichuan Province from 2018 to 2021 were selected as the research objects.Their hospitalization expenses and medical insurance settlement information were collected.And the patients were grouped according to the length of hospitalization.The new grey correlation analysis method and structural change analysis were used to quantitatively analyze the hospitalization expenses and medical insurance reimbursement data of rehabilitation patients.Results From 2018 to 2021,treatment cost was the most influential factor in the constituent ratio and correlation degree of the average hospitalization cost,followed by drug cost.The top 3 expenses contributing to structural changes were drug costs,treatment costs,and examination fees.The cost of drugs and beds showed a negative contribution change.The number of days of hospitalization had its particularity in group of more than 60 d,and its material cost had a greater impact on the constituent ratio and correlation degree of the average hospitalization cost.The reimbursement amount of the supplementary layer was the most influential factor in the constituent ratio and correlation degree of the average hospitalization expense reimbursement.The burden of patients continued to increase.Conclusion The burden of rehabilitation patients is still heavy under the multi-level medical security system.Commercial health insurance should focus on protecting the long-term inpatient rehabilitation patients.The cost structure of rehabilitation still needs to be optimized.And it is necessary to be vigilant against the rise in the cost of examination and consumables.It is necessary to continue to explore appropriate medical insurance payment methods for rehabilitation by taking into account the characteristics of disciplines and ensure the development momentum of key disciplines.
作者
唐金凤
王运莎
王寓凡
张昭
周晓媛
Tang Jinfeng(West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu,P.R.China)
出处
《中国卫生事业管理》
北大核心
2025年第8期888-892,897,共6页
Chinese Health Service Management
基金
科技部国家重点研发计划“健康管理综合服务应用示范”(2020YFC2006500)
成都市DRG支付方式改革研究采购项目“成都市DRG支付方式改革研究”(SQBX-2023-1105)。
关键词
康复费用
新灰色关联分析
多层次医疗保障体系
结构变动度
rehabilitation costs
New grey correlation analysis
multi-level medical security system
Structural variability
