过皓

摘要： 目的：比较分析医改前后生育定点医疗机构阴道分娩、剖宫产的费用，分析医改对生育保险单病种费用的影响。方法：抽取2015年1月-2016年7月在无锡市某三甲医院生育的参加无锡市生育保险的女职工373例作为研究对象，分为医改前生育保险单病种费用组和医改后生育保险单病种费用组，对比两组患者均次住院费用、生育定点医疗机构费用超支等。结果：医改后生育保险单病种费用组在均次住院费用方面较医改前有显著变化，医改后生育定点医疗机构超支剧增。结论：医改是导致生育医疗费用上涨的主因，应尽快调整生育保险单病种费用结算限额，适应医改需求，促进医学事业的健康、协调发展。

Abstract： Objective： To compare and analyze the cost of vaginal delivery and cesarean section before and after medical reform， and analyze the impact of health care reform on the disease cost of birth insurance. Method： 373 female workers who participated in maternity insurance in Wuxi in Wuxi from January， 2015 to July， 2016 were selected as the research object. They are divided into maternity insurance single disease cost before medicare reform and maternity insurance single disease cost after medicare reform. The hospitalization expenses， birth sentinel medical institutions cost overruns of the two groups are compared. Result： After the reform， the birth insurance single disease cost after the medical reform group had significant changes in the average hospitalization costs compared with that before the medical reform， the overruns of birth medical institutions after medical reform increased dramatically. Conclusion： The medicare reform is the main cause of fertility medical costs rising. The birth insurance single disease cost settlement limit should be adjusted as soon as possible to meet the needs of health care reform and promote the health and coordinated development of medical undertakings.

关键词： 生育保险；单病种费用；医改；影响

Key words： maternity insurance；single disease cost；medicare reform；influence

中图分类号：F842.6 文献标识码：A 文章编号：1006-4311（2017）05-0030-02

0 引言

2015年，国务院明确要进一步扩大城市公立医院综合改革试点。作为综合医改试点城市，无锡市从10月31日起全面实施城市公立医院综合改革。医改实施方案明确公立医院药品实行零差率销售，医院补偿由医疗服务收费、药品加成收入和政府补助三个渠道改为医疗服务收费和政府补助两个渠道。这次综合医改对公立医院带来了巨大的变化和影响。根据无锡市社保部门的规定，女职工在生育保险定点医疗机构发生的生育医疗费（不含妊娠期检查费），由社保经办机构与定点医疗机构按生育保险单病种费用限额结算。超过单病种费用限额标准的部分不予结算，低于限额标准的按实结算。……