摘要
目的分析跨省异地就医住院费用直接结算工作在上海儿童专科医院开展情况,为今后的工作提供参考依据。方法通过检索医院信息系统,调取95例研究对象的社会学基本信息、参保地信息、治疗及费用等相关数据。采用卡方检验、方差分析、秩和检验及Mann-Whitney U检验对数据进行统计分析。结果 69. 5%的患儿为5岁以下儿童。88. 4%的患儿原参保地为华东地区。97. 9%的患儿为转诊转院治疗。患儿疾病种类以恶性肿瘤及心血管疾病为主,43. 2%的患儿为第2次及以上住院,18. 3%的患儿住院次数在5次以上。84. 2%患儿在出院时即完成了实时结报,平均报销比例为55. 6%。不同省份/自治区参保患儿的住院费用、住院天数、结算天数、报销比例之间差异均无统计学意义。首次住院患儿报销比例略低于非首次住院患儿、手术患儿住院费用高于非手术患儿,报销比例最高的三种疾病类型为移植后治疗、心血管疾病、神经内外科疾病,差异具有统计学意义(P <0. 05)。结论建议进一步加大宣传力度及信息互联互通,扩大跨省异地就医住院费用直接结算覆盖面;结合医联体等措施,扩大分级诊疗,推进医疗资源合理利用。
Objective： To analyze the direct settlement of hospital expenses across provinces in Shanghai children’ s hospital,and provide references for future work.Method： The authors obtained the basic information of sociology,information of insured places,treatment and cost of 95 subjects by searching the information system of the hospital.Chi-square test,ANOVA,Kruskal-Wallis test and Mann-Whitney U test were used for statistical analysis of the data.Result： They find that 69.5% were children under the age of five.88.4% of the children were insured in east China and 97.9% of the children were referred to a hospital for treatment.The main types of diseases in children were malignant tumor and cardiovascular disease.43.2% were hospitalized for the second time or more,and 18.3% were hospitalized for more than 5 times.84.2% of the children completed real-time reporting upon discharge,with an average reimbursement rate of 55.6%.There were no statistically significant differences in the hospitalization expenses,length of stay,settlement days,and reimbursement rates of the insured children in different provinces/autonomous regions.The reimbursement rate of the first hospitalized children was slightly lower than that of the non-first hospitalized children,and the hospitalization cost of the surgical children was higher than that of the non-surgical children.The three types of diseases with the highest reimbursement rate were post-transplant treatment,cardiovascular disease and neurosurgery disease,and the difference was statistically significant （ P 〈0.05）.Conclusion： It is suggested to further strengthen the publicity and information interconnection and expand the coverage of direct settlement of medical and hospital expenses across provinces.Hierarchical diagnosis and treatment should be expanded,and rational use of medical resources be promoted by combining medical alliance and other measures.
作者
刘桦
柳龚堡
徐炜
杨荣华
翟晓文
LIU Hua;LIU Gong-bao;XU Wei;YANG Rong-hua;ZHAI Xiao-wen(Children＇s Hospital of Fudan University,Shanghai 201102,China)
出处
《现代医院管理》
2018年第5期21-25,共5页
Modern Hospital Management
关键词
儿童专科医院
跨省异地就医结算
即时结算
医联体
children＇ s hospital
cross-provincial medical settlement
instant settlement
medical alliance
