上海交通大学学报（医学版）

›› 2013, Vol. 33 ›› Issue (2): 214-.doi: 10.3969/j.issn.1674-8115.2013.02.018

• 论著（卫生事业管理） • 上一篇    下一篇

不同医疗保障水平对急性心肌梗死患者住院费用的影响

袁素维1, 李 娜1, 张云婷2, 顾 倩3, 刘 艳3, 马 进1   

  1. 1.上海交通大学 公共卫生学院, 上海 200025； 2.上海交通大学 医学院附属儿童医学中心党委办公室, 上海 200127； 3.上海交通大学 医学院附属瑞金医院心内科, 上海 200025
  • 出版日期:2013-02-28 发布日期:2013-03-07
  • 通讯作者: 马 进, 电子信箱: majin_sph@sjtu.edu.cn； 刘 艳, 电子信箱: liuyan_ivy@126.com。
  • 作者简介:袁素维（1989—）, 女, 硕士生； 电子信箱: yuansuwei@126.com。
  • 基金资助:

    国家自然科学基金（71273175, 71203141）

Effect of different health coverage on hospital expenditure of patients with acute myocardial infarction

YUAN Su-wei1, LI Na1, ZHANG Yun-ting2, GU Qian3, LIU Yan3, MA Jin1   

  1. 1.School of Public Health, Shanghai Jiaotong University, Shanghai 200025, China； 2.Children´s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China； 3.Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2013-02-28 Published:2013-03-07
  • Supported by:

    National Natural Science Foundation of China, 71273175, 71203141

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摘要：

目的 研究不同医疗保障水平对急性心肌梗死（AMI）患者住院费用的影响程度，评价上海市医疗保险政策对AMI患者住院费用的控制效果。方法 收集上海市某三级甲等综合性医院2007年1月—2012年8月入院的1 869例AMI患者的住院病历首页信息和医疗保险费用信息，以住院总费用为因变量、个人实际住院报销比例为自变量、其他相关因素为控制变量进行单因素分析和多因素回归分析。同时，将样本人群按政策变化时间分为两组，采用等级相关分析评价政策变化前后的费用控制效果。结果 不同保障水平对住院费用有显著影响，提高报销比例可以降低AMI患者的住院费用。报销比例每增加1%，患者住院总费用减少23.80元，行心脏介入手术治疗的患者住院总费用减少30.13元。医疗保险政策变化后，AMI患者疾病负担显著下降（P<0.000 1），但总体医疗费用无显著差别（P=0.087 4）。结论 患者实际报销比例相对于医疗保险类型是研究疾病住院费用更为精确的指标。政府应适当调整报销比例，引导居民合理消费，同时积极推进支付方式改革。

关键词: 急性心肌梗死, 住院费用, 报销比例, 医疗保险政策

Abstract:

Objective To investigate the effect of different health coverage on hospital expenditure of patients with acute myocardial infarction (AMI), and evaluate the effect of health insurance policy on control of hospital expenditure of patients with AMI in Shanghai. Methods The medical record home page information and health insurance payment information of 1 869 patients with AMI admitted to one tertiary comprehensive hospital in Shanghai between January 2007 and August 2012 were collected. With the reimbursement ratio as independent variable, total cost as dependent variable and the other related factors as controlled variables, univariate analysis and multivariate regression analysis were performed. Meanwhile, these patients were divided into two groups according to the time of change of health insurance policy, and the cost control effect after policy change was evaluated by rank correlation analysis. Results Insurance coverage was a main influencing factor of hospital expenditure, and the increase of reimbursement ratio led to the decrease of hospital expenditure in patients with AMI. The reimbursement ratio increased every 1%, the total hospital expenditure decreased 23.80 yuan, and the total hospital expenditure of patients treated with cardiac intervention decreased 30.13 yuan. The change of health insurance policy significantly released the economic burden on patients with AMI (P<0.000 1), but had no significant effect on total medical cost (P=0.087 4). Conclusion Compared with insurance type, the imbursement ratio is a more precise and sensitive variable to measure hospital expenditure. The government should properly adjust the reimbursement ratio, guide residents toward more rational medical consumption, and actively put forward payment reform.

Key words: acute myocardial infarction, hospital expenditure, insurance coverage, health insurance policy