摘要
目的分析医保支付方式改革下冠心病医疗保险患者住院费用中,次均费用变动情况和各类费用对总费用的影响,为合理控制冠心病患者的住院费用,提升医保基金使用效率提供理论依据。方法选取某三甲医院心内科2019-2022年6月主要诊断为冠心病的参保患者6368名,通过医院信息系统采集患者的住院费用信息,采用居民消费价格指数预处理消除价格因素对费用产生的影响,利用灰色关联分析各类费用与总费用的关联程度。结果2019-2022年6月冠心病参保患者住院费用次均费用先升后降。在灰色关联度分析中,材料费和药品费对总费用的关联度最高,分别为0.919和0.873。结论医保支付方式改革下,冠心病患者次均费用得到有效控制,同时冠心病参保患者住院费用医保监管重点应为材料费,其次为药品和检查检验费。
Objective To analyze the changes of sub-average costs and the impact of various types of costs on the total costs of hospitalization of medical insurance patients with coronary heart disease under the reform of medical insurance payment method,so as to provide a theoretical basis for reasonably controlling the hospitalization costs of patients with coronary heart disease and improving the efficiency of medical insurance fund use.Methods 6368 insured patients with the main diagnosis of coronary heart disease in the cardiology department of a tertiary hospital from 2019 to June 2022 were selected,and the hospitalization cost information of the above patients was collected through the hospital information system,and the influence of price factors on the costs was eliminated by using the pre-processing of the consumer price index,and the degree of association between various types of costs and the total costs was analyzed by using grey correlation.Results The subaverage cost of inpatient hospitalization for patients with coronary artery disease increased and then decreased from 2019 to June 2022.In the grey correlation analysis,material cost and drug cost had the highest correlation degree to total cost,0.919 and 0.873 respectively.Conclusion The sub-average cost of coronary heart disease patients was effectively controlled under the reform of medical insu-rance payment method,while the focus of medical insurance supervision of inpatient costs of coronary heart disease participants should be material cost,followed by drug and examination and test costs.
作者
杨帆
吕翔
童雪君
YANG Fan;LV Xiang;TONG Xuejun(Medical Insurance Office,Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu,225000,China)
出处
《中国社会医学杂志》
2023年第6期721-724,共4页
Chinese Journal of Social Medicine
基金
江苏省卫健委科研项目(CW202253)
扬州市反腐倡廉制度建设研究所项目(2022YZ108)。
关键词
冠心病
医疗保险
支付方式
改革
灰色关联法
Coronary heart disease
Medical insurance
Mode of payment
Reform
Grey correlation method
