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高晓娜, 李萍, 张才华, 储召群, 张丽晶, 陈迎春. 湖北省某县医院单病种定额付费实施效果分析[J]. 中国公共卫生, 2014, 30(10): 1299-1301. DOI: 10.11847/zgggws2014-30-10-20
引用本文: 高晓娜, 李萍, 张才华, 储召群, 张丽晶, 陈迎春. 湖北省某县医院单病种定额付费实施效果分析[J]. 中国公共卫生, 2014, 30(10): 1299-1301. DOI: 10.11847/zgggws2014-30-10-20
GAO Xiao-na, LI Ping, ZHANG Cai-hua.et al, . Implementation effect of singl disease based medical expense limitation in a county hospital in Hubei province[J]. Chinese Journal of Public Health, 2014, 30(10): 1299-1301. DOI: 10.11847/zgggws2014-30-10-20
Citation: GAO Xiao-na, LI Ping, ZHANG Cai-hua.et al, . Implementation effect of singl disease based medical expense limitation in a county hospital in Hubei province[J]. Chinese Journal of Public Health, 2014, 30(10): 1299-1301. DOI: 10.11847/zgggws2014-30-10-20

湖北省某县医院单病种定额付费实施效果分析

Implementation effect of singl disease based medical expense limitation in a county hospital in Hubei province

  • 摘要: 目的 分析县级医院单病种定额付费的实施效果及可能存在的问题,并提出改进的政策建议,为进一步发挥单病种付费的作用提供依据。方法 对湖北省当阳市某县医院2010—2012年实行单病种定额付费病种(胆囊结石及胆囊炎)的相关数据进行方差分析和非参数检验。结果 2010—2012年单病种定额付费的自付金额标准逐年下降,胆囊结石及胆囊炎手术治疗的自付费用标准从1 500元下降到1 070元,腹腔镜手术治疗的自付费用标准从2 150元下降到1 310元;病种纳入到单病种定额付费管理的比例不断提高,从75.00%增加到82.03%,其中2012年纳入腹腔镜手术治疗的比例达97.44%;腹腔镜手术治疗的住院天数由9.21 d下降到8.24 d,补偿比从50.55%提高到61.30%,自付费用从2 199.55元下降到1 777.62元,差异均有统计学意义(P<0.05);手术治疗总费用高于定额标准的比例从90.91%下降到25.00%,腹腔镜手术治疗总费用高于定额标准的比例从74.56%下降到32.24%,但患者实际支付的费用高于规定的标准。结论 按病种付费制度应继续贯彻执行,需要探索合理的付费标准,加大对医院执行的监管,加强对医生的引导和教育。

     

    Abstract: Objective To analyze implementation effect and problems of single disease based medical expense limitation(SDB-MEL) and to provide evidenses for the improvement of SDB-MEL.Methods Analysis of variance(ANOVA) and nonparametric tests were used to analyze the data on medical expenses for treatment of gallstone and cholecytitis in a county hospital of Dangyang city, Hubei province during 2010 through 2012 after the implementation of SDB-MEL.Results During the period, the sefl-paid medical expense quota decreased from 1 500 RMB yuan to 1 070 RMB yuan for operation treatment of gallstone and cholecytitis, and from 2 150 RMB yuan to 1 310 RMB yuan for laparoscopic surgery.The proportion of the patients under management of SDB-MEL increased from 75.00% to 82.03%, and that of the patients with laparoscopic surgery was 97.44% in 2012.The hospitalization days for the patients with laparoscopic surgery decreased from 9.21 to 8.24 while the compensation ratio increased from 50.55% to 61.30% and the amount of self-paid cost decreased from 2 199.55 RMB yuan to 1 777.62 RMB yuan, with significant differences(P<0.05).The ratio of the total cost higher than the quota of SDB-MEL decreased from 90.91% to 25.00% for total operation fee and from 74.56% to 32.24% for laparoscopic surgery.But the medical expense paid actually by the patients was higher than the quota.Conclusion The SDB-MEL should be implemented continuously but reasonable quota and needs to be estimated and superoision on SDB-MEL management needs to be promoted.

     

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