【摘要】：目的從2003年以來(lái)，河北省先后建立了針對(duì)農(nóng)村居民的新型農(nóng)村合作醫(yī)療和針對(duì)城鎮(zhèn)非從業(yè)居民的城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)。但由于這兩種醫(yī)保政策管理程序、參保人群、保障待遇等多方面規(guī)定都不相同，導(dǎo)致城鄉(xiāng)居民住院醫(yī)療費(fèi)用間存在差距。本文對(duì)河北省某縣城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)和新型農(nóng)村合作醫(yī)療的實(shí)施情況進(jìn)行分析，在此基礎(chǔ)上對(duì)兩種不同醫(yī)療保險(xiǎn)制度下，患者的住院醫(yī)療費(fèi)用進(jìn)行比較研究，深入了解住院費(fèi)用的構(gòu)成和影響因素，探討導(dǎo)致住院醫(yī)療費(fèi)用上漲的主要原因，進(jìn)而提出控制住院醫(yī)療費(fèi)用增長(zhǎng)的控制措施，為完善城鄉(xiāng)居民醫(yī)療保障制度提供參考。 方法資料來(lái)源于河北省某縣醫(yī)療保險(xiǎn)中心、新農(nóng)合管理系統(tǒng)，選取該縣2011年1月到2011年12月31日本地住院的城鎮(zhèn)居民醫(yī)�；颊吆托罗r(nóng)合患者，，作為研究對(duì)象。收集患者個(gè)人詳細(xì)信息及住院費(fèi)用的相關(guān)數(shù)據(jù)，將患者所有資料錄入excel建立數(shù)據(jù)庫(kù)，對(duì)患者人口學(xué)資料、住院費(fèi)用基本情況和構(gòu)成情況進(jìn)行一般性統(tǒng)計(jì)描述，住院費(fèi)用構(gòu)成包括住院總費(fèi)用、藥費(fèi)、治療費(fèi)、檢查費(fèi)、手術(shù)費(fèi)、特檢費(fèi)和床位費(fèi)，比較兩種醫(yī)療保障制度下患者住院費(fèi)用的差別；采用SPSS19.0統(tǒng)計(jì)軟件對(duì)住院費(fèi)用的影響因素進(jìn)行單因素和多因素分析。主要采用的統(tǒng)計(jì)方法有Mann-Whitney U檢驗(yàn)、 Kruskal-Willas H檢驗(yàn)、多元逐步回歸分析。 結(jié)果1住院醫(yī)療費(fèi)用構(gòu)成中，城鎮(zhèn)居民醫(yī)保患者的藥費(fèi)、治療費(fèi)和檢查費(fèi)的構(gòu)成比是53.76%、13.29%和9.91%；新農(nóng)合患者的藥費(fèi)、治療費(fèi)和檢查費(fèi)為52.95%、15.86%和12.05%，分別排在兩種醫(yī)�；颊咦≡嘿M(fèi)用的前三位。2住院醫(yī)療費(fèi)用支付方式上，城鎮(zhèn)居民醫(yī)�；颊邆�(gè)人支付比例12.54%，統(tǒng)籌支付比例87.46%；新農(nóng)合患者個(gè)人支付比例和統(tǒng)籌支付比例分別為33.60%和66.40%。3城鎮(zhèn)居民醫(yī)�；颊吆托罗r(nóng)合患者住院費(fèi)用比較：城鎮(zhèn)居民醫(yī)�；颊叩钠骄≡嘿M(fèi)用（2069.77元）高于新農(nóng)合患者平均住院費(fèi)用（1936.11元）；城鎮(zhèn)居民醫(yī)保患者的藥費(fèi)、檢查費(fèi)、特檢費(fèi)和手術(shù)費(fèi)均高于新農(nóng)合患者，差別有統(tǒng)計(jì)學(xué)意義（P＜0.05）。4城鎮(zhèn)居民醫(yī)�；颊咦≡嘿M(fèi)用的影響因素有年齡、住院天數(shù)、有無(wú)手術(shù)和醫(yī)院級(jí)別�；颊吣挲g越大，住院時(shí)間越長(zhǎng)，住院費(fèi)用越高；進(jìn)行手術(shù)和大型檢查項(xiàng)目使得患者住院費(fèi)用增高；就診于二級(jí)醫(yī)院的患者住院費(fèi)用高于基層一級(jí)醫(yī)院。5新農(nóng)合患者住院費(fèi)用的影響因素為性別、年齡、住院天數(shù)、有無(wú)大型檢查、有無(wú)手術(shù)和醫(yī)院級(jí)別。男性患者住院費(fèi)用明顯高于女性患者；住院時(shí)間越長(zhǎng)，患者住院費(fèi)用越多；不同年齡組的患者間住院醫(yī)療費(fèi)用有差異，差別具有統(tǒng)計(jì)學(xué)意義（P＜0.05）；手術(shù)患者住院費(fèi)用高于非手術(shù)患者；就診于二級(jí)醫(yī)院患者住院費(fèi)用高于一級(jí)醫(yī)院患者。 結(jié)論1不同醫(yī)療保障制度下，城鎮(zhèn)居民醫(yī)�；颊叩淖≡嘿M(fèi)用高于新農(nóng)合患者。2新農(nóng)合統(tǒng)籌基金補(bǔ)償水平低于城鎮(zhèn)居民醫(yī)保，有待進(jìn)一步提高。3根據(jù)病情選擇就診醫(yī)院，在明確診斷的前提下，嚴(yán)格掌握用藥指征和手術(shù)適應(yīng)癥，降低住院天數(shù)，減少藥費(fèi)比重，能減少住院費(fèi)用，減輕患者個(gè)人及統(tǒng)籌基金支付壓力。
[Abstract]:Objective Since 2003, Hebei province has established a new rural cooperative medical system for rural residents and basic medical insurance for urban residents of non-residents in cities and towns. However, because these two kinds of health insurance policy management procedures, the insured people, the safeguard treatment and so on various regulations are different, resulting in the gap between the medical expenses between the urban and rural residents. This paper analyzes the implementation of the basic medical insurance and the new rural cooperative medical system in a county of Hebei Province. On the basis of this, the medical expenses of the patients are compared and studied in two different medical insurance systems, and the composition and influencing factors of hospitalization expenses are deeply understood. This paper discusses the main causes of the increase in hospital medical expenses, and then puts forward the control measures to control the increase of hospital medical expenses and provides reference for perfecting the medical insurance system of urban and rural residents. Methods From January 2011 to December 31, 2011, the medical insurance center and Xinong Joint Management System of a county in Hebei Province were selected. Object: Collect relevant data of patient's personal details and hospitalization expenses, input all the data in the patient to excel to establish a database, make general statistical description of patient demographic data, basic conditions and composition of hospitalization expenses, including total hospitalization expense, medical expense, treatment The difference of hospitalization expenses of patients under the two medical security systems was compared with the treatment fee, examination fee, operating fee, special examination fee and bed position fee. The factors influencing the hospitalization cost were single factor and multi-factor. Analysis. The main statistical methods were Mann-Whitney U test, Kruskal-Willas H test, multivariate stepwise regression. Results 1 The composition ratio of medical expenses, treatment fee and examination fee for medical insurance patients of urban residents was 53. 76%, 13. 29% and 9. 91%. The medical expenses, treatment cost and examination fee of Xinong patients were 52. 95%, 15. 86% and 1. 2. 05%, in the first three of the two medical insurance patients' hospitalization expenses. In the way of hospital medical expenses payment, the proportion of personal payment of urban residents' medical insurance patients was 12.54%, and the proportion of total payment was 8. 7. 46%; the proportion of individual payment and the overall payment proportion of the new farmers are 33. 60% and 66. 40%, respectively. The average hospitalization expenses of urban residents' medical insurance patients (2069. 77 yuan) are higher than the average hospitalization expenses of new farmers (1936). (11) The medical expenses, examination fee, special inspection fee and operating expenses of medical insurance patients of urban residents were higher than those of new farmers. The difference was statistically significant (P <0.05). The influencing factors of hospitalization expenses for urban residents of urban residents were age, number of hospitalization days, and operation. The higher the patient's age, the longer the hospital stay, the higher the hospitalization cost, the higher hospitalization cost of patients who underwent surgery and large-scale examination, the hospitalization cost of patients with secondary hospitals was higher than that of the primary-level hospital. Sex, age, number of days in hospital, presence or absence of large-scale examination, presence or absence of surgery The hospitalization cost of male patients was significantly higher than that in female patients, the longer the hospitalization time, the higher the hospitalization cost of patients, the difference in hospitalization expenses among patients with different age groups, the difference was statistically significant (P <0.05). Non-surgical patients; hospitalization expenses for patients with secondary hospital higher than 1 Conclusion 1 In different medical security systems, the cost of hospitalization for urban residents in medical insurance is higher than that of new farmers. The compensation level of new non-agricultural integrated fund is lower than that of urban residents, which needs to be further improved. Under the precondition of definite diagnosis, strictly master the medication finger sign and surgical indication, reduce the number of hospitalization days, reduce the specific gravity of medical expenses, reduce hospitalization expenses, reduce the patient's personal and
【學(xué)位授予單位】：河北聯(lián)合大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R197.1;F842.684

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