摘要
目的分析基于风险预警评估系统下的危重孕产妇住院费用及商业医保的支付探索。方法对上海交通大学附属第六人民医院2017年3063位产科患者按不同保险类别、预警分级及住院费用进行分析。结果2017年产科出院患者中城镇职工医保2133人次,城镇居民医保36人次,自费患者894人次。绿色预警1221人次,黄色预警878人次,橙色预警935人次,红色预警29人次;绿色患者均次费用5323元,黄色预警患者均次费用7993元,橙色预警患者均次费用9428元,红色预警患者均次费用37919元。结论患者住院费用分别受年龄、医保类型(城镇职工医保)、预警分级和住院天数影响,有统计学意义。基于不同分级预警下的产科患者保险服务,有助于提高保险的精细化和科学化,并降低患者负担。
Objective To analyze the expenses of obstetric patients and explore the payment of commercial medical insurance based on risk early warning and evaluation system.Methods To analyze the whole 3063 obstetric patients in Shanghai Sixth People's Hospital in 2017 according to different insurance categories,early warning classification and hospitalization expenses.Results In 2017,2133 cases of medical insurance for urban employees,36 cases of medical insurance for urban residents and 894 cases of self-expenditure patients were discharged from obstetrics.Green warning 1221 people,yellow warning 878 people,orange warning 935 people,red warning 29 people;green patients average cost was 5323RMB,yellow warning patients average cost was 7993RMB,orange warning patients average cost was 9428RMB,red warning patients average cost was 37919RMB.Conclusion The hospitalization expenses of patients were affected by age,type of medical insurance(urban workers medical insurance),early warning classification and length of stay,with statistical significance.The introduction of maternity patient insurance services based on different levels of early warning will help to improve the refinement and scientification of insurance,and reduce the burden of patients.
作者
俞骏仁
陶敏芳
YU Junren;TAO Minfang(Medical Insurance Office,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200233;Institute of Hospital Management,China Hospital Development Institute,Shanghai Jiao Tong University,Shanghai 200233)
出处
《解放军医院管理杂志》
2019年第11期1011-1013,1020,共4页
Hospital Administration Journal of Chinese People's Liberation Army
基金
上海市卫生和计划生育委员会课题:基于风险分级预警的高危孕产妇医疗保障模式的研究(201740164)
关键词
风险预警
医疗费用
商业医保
risk warning
medical expenses
commercial medical insurance
