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目的:调查菏泽市公立医院5种慢性非传性染疾病(以下简称慢性病)医疗费用的支付方式。方法:收集2012年1月1日至2015年12月31日菏泽市市立医院、第二人民医院、第三人民医院、市中医医院和传染病医院收治的符合纳入标准的高血压、糖尿病、冠心病、慢性支气管炎和乙肝5种慢性病患者8 383例为研究对象,采集病案首页资料和住院费用明细进行分析。结果:医保患者人均住院总费用、检查费和其他费用显著高于非医保患者(P<0.05),医保患者人均药费显著低于非医保患者(P<0.05);在医保患者中,男性患者住院总支出均显著高于女性(P<0.05),45岁以上患者医保支出和住院总支出均显著高于45岁以下患者(P<0.05),退休患者医保支出和住院总支出高于在职患者(P<0.05),城镇居民自费支出、医保支出和住院总支出均显著高于农村居民(P<0.05)。结论:慢性病患者的支付方式与其住院费用具有密切关系,同时其住院费用也与社会经济学特征有关。值得注意的是,医保在保障居民健康的同时,也极有可能产生过度医疗和资源浪费,需要结合社会实际情况采取综合措施。
Objective: To investigate the payment of medical expenses for five kinds of chronic non-infectious diseases (hereinafter referred to as chronic diseases) in Heze Public Hospital. Methods: The data collected from January 1, 2012 to December 31, 2015 in Heze Municipal Hospital, Second People’s Hospital, Third People’s Hospital, Shanghai Traditional Chinese Medicine Hospital and Infectious Diseases Hospital were enrolled in accordance with the standards of hypertension, diabetes mellitus, 8383 cases of heart disease, chronic bronchitis and 5 chronic hepatitis B patients were selected as the research object, the first page of the medical records and the details of the hospitalization expenses were collected for analysis. Results: The total cost of per capita hospitalization, examinations and other expenses for Medicare patients were significantly higher than those for non-Medicare patients (P <0.05), and the per capita medical expenses for Medicare patients were significantly lower than those for non-Medicare patients (P <0.05). Among Medicare patients, The total expenditure on hospitalization was significantly higher than that on women (P <0.05). The expenditure on health insurance and total hospitalization for those over 45 years old were significantly higher than those under 45 years old (P <0.05). The retirement patients’ total expenditure on health care and hospitalization was higher than that on the job (P <0.05). Expenditure for urban residents at their own expense, health care expenditure and total hospital expenditure were significantly higher than rural residents (P <0.05). Conclusion: The payment of chronic diseases is closely related to the cost of hospitalization, and the cost of hospitalization is also related to socio-economic characteristics. It is worth noting that, while protecting the health of residents, medical insurance is also highly likely to cause over-medical treatment and waste of resources. Comprehensive measures must be taken in the light of the actual social conditions.