摘要
目的通过对全市城镇职工、城镇居民医保慢性病患者就医状况及管理模式进行分析研究,寻找影响因素,探讨新型慢性病管理模式以及通过医保支付方式改革途径形成慢性病患者分级诊疗的有序模式。方法通过医保大数据系统筛查对蚌埠市近三年来城镇职工、城镇居民医保慢性病患者在市一级、二级、三级医疗机构的就医状况(人群、病种、次数)及相关医疗费用进行分级别、分段统计分析。结果绝大部分慢性病患者仍愿意选择治疗条件好、级别高的医疗机构作为自己就诊的定点医疗机构,医疗费用占比达90%。结论通过支付方式改革,有效引导部门慢性病病人能够到基层医疗机构就诊,起到有效控制医疗费用,减轻慢性病患者家庭的经济负担以及有效缓解医疗保险基金的压力的关键作用。实行多元化的支付方式,引导形成科学合理就医秩序,建立符合国情的分级诊疗制度。
Objective To analyze the medical treatment status and management mode of the city’s urban employees and urban residents with medical insurance for chronic diseases,to find influencing factors,to explore the new management model for chronic diseases and to form an orderly model of graded diagnosis and treatment for chronic disease patients through the reform of medical insurance payment methods.Methods The medical insurance big data system was used to screen the medical treatment status(population,disease type,frequency)and related medical expenses of urban employees and urban residents with chronic diseases in the city's first-,second-and third-tier medical institutions in the past three years were statistically analyzed by level and segment.Results The vast majority of patients with chronic diseases are still willing to choose medical institutions with good treatment conditions and high-level medical institutions as their designated medical institutions,and medical expenses accounted for 90%.Conclusion Through the reform of payment methods,the department can effectively guide patients with chronic diseases to visit primary medical institutions,play a key role in effectively controlling medical expenses,reducing the economic burden of chronic disease patients’families,and effectively alleviating the pressure on medical insurance funds,implement diversified payment methods,guide the formation of a scientific and reasonable order for medical treatment,and establish a hierarchical diagnosis and treatment system in line with national conditions.
作者
李磊
田瑞雪
LI Lei;TIAN Ruixue(Medical Insurance Office,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui Province,233004 China)
出处
《中国卫生产业》
2021年第3期14-16,共3页
China Health Industry
基金
蚌埠医学院科研课题(BYKF1836)。
关键词
基本医疗保险
门诊慢性病
疾病负担
支付方式
Basic medical insurance
Outpatient chronic disease
Disease burden
Payment method
作者简介
李磊(1982-),男,硕士,高级经济师,主要研究方向为医疗保险及慢性病患者管理。
