Objective: To explore the level and influential factors for out-of-pocket (OOP) expenditure regarding Hunan Provincial Urban Employee Basic Medical Insurance (UEBMI) and to provide evidence for improvement of medical insurance payment system.
Methods: Stratified random sampling method was used to obtain 10 527 records of cancer inpatients from January 2011 to December 2014. Social demographic and expenditure information were collected from UEBMI information system. The proportion of OOP expenditure for inpatient and each part of the cost was described. Multiple linear regression was used to analyze main related factors of OOP expenditure.
Results: The median proportion of OOP for inpatients costs was 20.11%, and remained stable from 2011 to 2014. The main related factors for OOP expenditure were age, civil servant, retirment status, hospital level, cost of hospitalization, hospitalization duration, medicine cost, proportion of general medical service charges, treatment cost, expenses of examination and laboratory test, and cancer type.
Conclusion: OOP expenditure among UEBMI cancer inpatients was under control and stable. The level can well reflect the policy preferences. It could be further improved through the control of related factors, particularly the hospital level.
目的：了解湖南省直城镇职工基本医疗保险参保恶性肿瘤住院患者的自付比例水平，分析其相关因素，以期为医保支付制度的完善提供信息。方法：采用随机分层抽样的方法抽取2011年1月至2014年12月有出院记录的参保恶性肿瘤患者10 527人次，在信息系统中收集一般社会人口学与费用等相关资料。计算自付比例与各部分费用的构成。采用多元线性回归分析自付比例的主要相关因素。结果：患者住院自付比例中位数为20.11%，在2011年至2014年保持平稳。患者住院自付比例主要相关因素包括年龄、是否公务员、是否退休、医院级别、住院费用、住院周数、药费构成比、一般医疗服务费构成比、治疗费构成比、检查化验费构成比及肿瘤类别。结论：恶性肿瘤住院患者的自付比例控制平稳，自付比例的差异能反映补偿政策的倾向，应以医院级别为主要着眼点进一步予以控制。.