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目的 了解费用变化与参保者就医取向 ,分析费用增长原因与控制效果 ,提出政策建议。方法 用SPSS和Excel对南通市 2 0 0 0年至 2 0 0 2年在职和退休人员医疗保险实际数据进行统一分析。结果 ①“板块式”管理和“总量控制、均值管理”的支付方式有较好的费用控制效果 ,特别是对门诊费用的控制、住院费用的增长有加快表现。②住院医疗取向三级医院 ,门诊选择次均费用低的卫生所、室和定点药店增多。讨论 ①医疗保险管理方应加强对费用控制策略的研究与探讨 ,引导病人的合理分流 ,科学控制费用 ,提高基金利用效率。②医疗机构面对机遇与危机 ,应加强质量建设 ,提供规范、诚信服务。③加强区域卫生规划 ,提高卫生资源利用效率。
Objective To understand the changes in costs and the orientation of medical treatment for insured persons, analyze the causes of cost increase and the control effects, and put forward policy recommendations. Methods The actual data of health insurance for employed and retiree in Nantong from 2000 to 2002 were analyzed by SPSS and Excel. Results ① The management methods of “plate type” and the methods of “total amount control and mean value management” had better cost control effects, especially for the control of outpatient expenses, and the growth of hospitalization expenses accelerated. ② hospital-oriented tertiary hospitals, clinics choose the average cost of low-cost health centers, hospitals and designated pharmacies increased. Discussion ①Medical insurance managers should strengthen the research and discussion on cost control strategies, guide patients to rationally diversion, scientifically control costs and improve fund utilization efficiency. ② In the face of opportunities and crises, medical institutions should enhance their quality and provide standardized and honest services. ③ strengthen regional health planning, improve the utilization efficiency of health resources.