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我省医疗保险制度的改革经过一年多的运行,出现了医疗费用不正常上升的现象和趋势,通过对省医保中心定点的32家医疗机构中部份三级甲等医院、三级乙等医院、专科医院参保患者的住院次数、次均费用以及药品费用占总费用比例情况进行统计分析发现:1、住院人次数逐渐上升:在同一等级医院中,其住院人次数在逐季度上升,三甲医院从第一季度275住院人次数上升到第四季度的1009人次数;专科医院从第一季度21住院人次数上升到第四季度的257人次数;三甲医院住院收治比例在3%-4%之间,专科医院住院收治比例高达6%-9%,社会人群住院收治比例一般在2.5%左右。造成住院人次数上升的原因:(1)、医改启动之初,参保人员对政策不了解,担心个人负担太重不敢贸然住院。(2)、医生对住院条件掌握不严格。由于目前政府对医院实现差额拨款,政府的拨款不能满足院方发展的需要,医院就通过多收病人达到多创收,来弥补经费上的不足;另一方面,为了防止医疗纠纷的发生,医生将一些可以在门诊治疗的病人也收住院
After more than a year of operation, the reform of the medical insurance system in our province led to the phenomenon and trend of the abnormal increase of medical expenses. Through the inspection of 32 medical institutions designated by the provincial medical insurance center, some third-level hospitals, third-level hospitals and so on The number of inpatients, the average cost and the proportion of the total cost of the insured patients in hospitals and specialty hospitals were statistically analyzed. The results showed that: 1, the number of inpatients increased gradually: the number of inpatients in the same level hospitals rose quarter by quarter, The number of top three in-service hospitals rose from 275 in the first quarter to 1009 in the fourth quarter; the number of specialist hospitals rose from 21 in the first quarter to 257 in the fourth quarter; the number of hospitalizations admitted to the top three hospitals was between 3% -4 %, Specialist hospital admission rate of up to 6% -9%, the proportion of people admitted to hospital generally 2.5%. Reasons for the increase in the number of inpatients: (1) At the beginning of the medical reform, the insured persons did not understand the policy and feared that the individual would not be able to rush into the hospital with too much burden. (2), the doctor is not strict on the condition of hospitalization. Due to the current government funding for the balance of the hospital, the government funding can not meet the needs of the development of the hospital, the hospital will achieve more revenue through more patients to make up for lack of funding; the other hand, in order to prevent medical disputes, the doctor will Some patients who can be treated in the clinic are also admitted to the hospital