摘要
目的通过比较新疆某三级医院职工医保与居民医保老年人住院费用及报销水平的差别,发现存在的问题,为进一步完善医保相关政策提供建议。方法选取两种医保老年住院患者为研究对象,对其住院及医保报销费用数据进行分析,比较不同医保老年人住院费用及其医保报销的差别。结果两类医保住院老年患者以慢性病为主,排在前6位的均为慢性病,其中职工医保占39.1%,居民医保占40.7%;老年患者住院次均总费用为10 410.4元,居民医保11 078.1元、职工医保10 783.8元,两类医保老年患者均大于全院平均水平;在费用构成上药品费在两类医保对象住院费用的构成中都占近44.0%;在个人负担上职工医保个人负担率为27.5%,居民医保为45.1%。结论老年人住院费用高,医院应从住院天数、药品费用方面重点监控;医保部门应重点监管医保药品目录外药品的使用,在报销政策上要考虑年龄因素的影响,适当提高老年人慢病的门诊可报费用标准;提高居民医保的报销水平,以减轻居民医保老年患者的经济负担。
Objective： To compare gaps of medical insurance for medical workers in a Xinjiang hospital of class three,senior residents＇ hospitalization fees and reimbursement,discover the existing problems and provide suggestions on further improving relevant policies of medical insurance. Method： The authors selected senior inpatients with two kinds of medical insurance reimbursement,analyzed data about their hospitalization and medical insurance,and compared the gaps between different senior hospitalization fees and medical insurance reimbursement. Result： Most of the senior patients with two kinds of hospitalization fees and reimbursement are chronic disease sufferers,of whom medical insurance of medical workers accounts for 39. 1%,and resident medical insurance,40. 7%; Senior hospitalization fees each time is $ 10,410. 4,of which $ 11,078. 1 for residents,and $ 10,783. 8 for medical workers,which means the two kinds are larger than the average of the whole; Drug fees in expenditure components of the two kinds account for nearly 44. 0%; Individual coverage of medical workers is 27. 5%,and resident,45. 1%. Conclusion： Therefore,senior hospitalization fee is high. Hospitals should focus on the days of hospitalization and drug fees. Medical insurance department should monitor and manage drug use out of drug list involved in medical insurance,and the reimbursement policy should be tilted to age,which means to upgrade reimbursement for the seniors with chronic diseases and cover more of resident medical insurance so as to reduce economic load of seniors enjoying resident medical insurance.
出处
《现代医院管理》
2016年第5期51-54,共4页
Modern Hospital Management
基金
科技支疆计划项目(2014AB042)
关键词
医疗保险
老年患者
住院费用
统筹基金
medical insurance
senior patient
hospitalization expense
consolidated fund
