| 引用本文: |
王凤明,王宾,王敬.新医改下职工医保住院费用运行规律分析[J].中国卫生经济,2023,42(5):37-40.[点击复制] |
WANG Feng-ming,WANG Bin,WANG Jing.Research and Analysis on the Operational Rules of Hospitalization Medical Expenses for Employee Medical Insurance under the New Medical Reform[J].CHINESE HEALTH ECONOMICS,2023,42(5):37-40.[点击复制] |
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| 摘要: |
| 目的：为促进医保、医疗、医药协同发展，通过对新医改下山东省职工医保住院费用运行规律分析，提高职工医保综合治理和改革水平。方法：采用描述统计分析，运用Excel2021工具分析费用支出规模、结构、分布等运行规律和发展趋势。结果：住院费用持续增长，主要集中在三级医疗机构。药品费用呈下降趋势，诊疗项目费用占比较大，并逐年增长。个人负担较重，老龄化加快，导致费用支出不断加大。结论：医保基金运行存在潜在风险，需要不断提高抗风险的能力。医疗费用持续上涨，需要建立更加合理的控费机制。住院费用呈现聚集性分布，需要进一步加强对重点医疗机构的管控。医疗费用结构呈现新特点，需要重点加强诊疗项目价格管理。个人负担仍然较重，需要进一步健全完善多层次的医疗保障体系。 |
| 关键词: 职工医疗保险 住院费用 运行规律 新医改 |
| DOI： |
| 投稿时间：2023-02-15 |
| 基金项目: |
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| Research and Analysis on the Operational Rules of Hospitalization Medical Expenses for Employee Medical Insurance under the New Medical Reform |
| WANG Feng-ming,WANG Bin,WANG Jing |
| () |
| Abstract: |
| Objective: In order to promote the coordinated development and management of medical insurance，medical treatment and medicine，it intends to improve the comprehensive management and reform level of employee medical insurance through the analysis and research of the operational rules of hospitalization medical expenses under the new medical reform. Methods: Descriptive statistical analysis and Excel are used to analyze the operational rules and development trends of expenditure scale，structure，distribution，etc. Results: The cost of inpatient medical treatment continuous to increase and are concentrated in tertiary medical institutions. The cost of drugs has shown a downward trend，and the cost of diagnosis and treatment projects accounts for a relatively large proportion，which has increased year by year. The personal burden is heavy，and the aging is accelerating，resulting in increasing expenses. Conclusion: There are potential risks in the operation of the fund，and it is necessary to constantly improve the ability to resist risks. As medical expenses continue to rise，it is necessary to establish a more reasonable fee control mechanism. Hospitalization expenses show a clustered distribution，and the control of key medical institutions needs to be further strengthened. The medical cost structure shows new characteristics，and it is necessary to focus on strengthening the prices management of medical treatment items. The personal burden is still heavy，and the multi-level medical security system needs to be further improved. |
| Key words: employee medical insurance hospitalization expense law of operation |
