摘要
目的分析张家口市2023年异地就医直接结算医保患者流向及聚类特征,为科学制定医保基金统筹政策,合理利用医疗资源提供参考。方法使用SPSS 22.0对张家口市2023年参保异地就医直接结算数据进行描述性统计及系统聚类分析。结果张家口市2023年异地就医主要流入地为北京地区,总人数占比66%,北京地区总医保基金支出占比77%。聚类后结果,第一类1个省市为北京市,就诊人员数量占比超50%;第二类2个省市,为上海、安徽长江三角洲地区;第三类1个省市为河北省其他地市。结论异地就医受地理位置、医疗资源集中程度、患者就医意愿等多因素影响,张家口患者主要流入医疗资源集中的北京、上海等优势地区,对环京地区的张家口形成巨大虹吸效应,也反向作用于本地医疗服务的发展。建议对基础病、常见病加大资源投入比例,提高疑难危急患者救治扶持力度,提高患者本地就医意愿,引导患者合理就诊,避免医疗资源不合理利用,减轻患者就医负担。
Objective To analyze the flow and clustering characteristics of direct settlement of medical insurance patients in Zhangjiakou City in 2023,so as to provide reference for scientific formulation of medical insurance fund coordination policy and rational utilization of medical resources.Methods SPSS 22.0 was used to conduct descriptive statistics and systematic cluster analysis on the direct settlement data of medical insurance in Zhangjiakou in 2023.Results In 2023,the main inflow area of off-site medical treatment in Zhangjiakou City was Beijing,accounting for 66%,with 77%of the total medical insurance fund expenditure.After clustering,the first category of 1 province and city was Beijing,and the number of patients accounted for more than 50%;the second category of 2 provinces and cities,were Shanghai,Anhui Yangtze River Delta region;the third category of 1 province and city was other cities in Hebei Province.Conclusion Off-site medical treatment is affected by many factors such as geographical location,concentration of medical resources,and patients'willingness to seek medical treatment.Zhangjiakou patients mainly flow into advantageous areas such as Beijing and Shanghai,where medical resources are concentrated,forming a huge siphon effect on Zhangjiakou in the region around Beijing.It also reverses the development of local medical services.It is suggested to increase the proportion of resource investment in basic diseases and common diseases,improve the support for the treatment of difficult and critical patients,improve the willingness of patients to seek medical treatment locally,guide patients to seek medical treatment reasonably,avoid the unreasonable utilization of medical resources,and reduce the burden of patients seeking medical treatment.
作者
宋仪昕
刘超
张文绪
贾磊
周寅
叶佳慧
陈敏霞
刘斌
SONG Yi-xin;LIU Chao;ZHANG Wen-xu;JIA Lei;ZHOU Yin;YE Jia-hui;CHEN Min-xia;LIU Bin(Department of Medical Record Management,The Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China;Medical Department,The Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China;Institute of Hospital Management,Shenzhen International Graduate School,Tsinghua University,Shenzhen,Guangdong 518000,China)
出处
《河北北方学院学报(自然科学版)》
2025年第8期39-42,共4页
Journal of Hebei North University:Natural Science Edition
基金
2023年度河北省医保医疗保障研究课题(No.JYB23039)。
关键词
异地就医
直接结算
系统聚类
特征分析
Off-site medical treatment
Direct settlement
System clustering
Characteristic analysis
作者简介
宋仪昕(1989-),女,内蒙古呼伦贝尔人,中级统计师,研究方向:病案信息挖掘、疾病编码等。
