基于东方医院住院患者医保支付情况的疾病分析.docVIP

基于东方医院住院患者医保支付情况的疾病分析 　　[摘要] 目的 分析基于东方医院（以下简称“我院”）住院患者医保支付的疾病情况，论述住院患者医保支付的主要疾病，提出医院控制医疗费用的重点部分和环节，以达到平衡年度医院医保支付总额度的要求。 方法 2012年1月～2014年12月对我院医保住院患者的相关资料进行分析，以医院每年医保支付费用为基础，对住院医保支付费用的去向进行分析，重点分析年度医保费用占用比例较高的科室与疾病。 结果 2012～2014年度全院支付总费用与医保支付费用逐年上升，其中肿瘤病与冠心病的支付总费用与医保支付费用占30.0%以上，而医保支付比例都在76.0%以上。支付总费用与医保支付费用占据前两位科室都为肿瘤科与心血管内科，支付总费用与医保支付费用在32.0%以上，医保支付比例也都在76.0%以上。 结论 东方医院住院患者医保支付主要为肿瘤病与冠心病，需要完善和提高肿瘤病、冠心病、脑梗死、糖尿病等疾病的治疗，加大措施降低平均住院天数、药品费比例，加快床位周转 [关键词] 东方医院；医疗保险；住院费用；医保支付；疾病 [中图分类号] R197 [文献标识码] A [文章编号] 1674-4721（2016）09（c）-0147-05 [Abstract] Objective To analysis the diseases situation based on the medical insurance payment in Dongfang Hospital， discuss the major diseases by the medical payment， put forward hospital control key parts of medical expenses and links， to achieve the balance of every year hospital medical insurance and the total amount of payment. Methods From January 2012 to December 2014， related data of medical-insured patients in our hospital were given analysis， based on cost of payment of annual hospital medical insurance， the whereabouts hospitalized medicare payments were analyzed， relative higher proportion of departments and disease of annual medicare cost occupy were selectively analysed. Results The hospital pay total cost and medicare payment costs were increased year by year， which tumor disease and coronary heart disease payment of the total costs and health insurance payment costs accounted for more than 30.0%， and medical insurance payment accounted the proportion of 76.0%. The top two payment of the total cost of health insurance payments departments were oncology and cardiovascular medicine that accounted for more than 32.0%， the proportion of Medicare payments was also more than 76.0%. Conclusion Dongfang Hospital inpatient medical insurance payments for the main support are cancer disease and coronary heart disease. It is required to improve the treatment of tumor diseases， coronary heart disease， cerebral infarction and diabete