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目的分析基层医院病例分型和医疗费用的特点。方法以某一级甲等公立医院为例,通过对使用新版病例首页的住院病例数据进行分析,总结病例分型结构特点,比较医保及非医保患者的医疗费用差异,测算主因病种标准医疗费用的参考范围。结果该医院AB率高达96.9%;各分型医保患者费用均高于非医保患者;标准费用参考范围可用于制定医保偿付标准及医疗质量费用管理。结论基层医院以单纯性病例为主,医保资金可能存在低效使用和浪费,适合推行简单可行的病例分型技术。
Objective To analyze the characteristics of primary hospital cases and medical expenses. Methods Taking a class A public hospital as an example, by analyzing the data of inpatients using the first page of the new version of the case, summarizing the structural characteristics of the case classification, comparing the difference of medical expenses between the medical insurance and non-medical insurance, and calculating the standard medical expenses The reference range. Results The AB rate of the hospital was as high as 96.9%. The cost of each type of Medicare patients was higher than that of non-Medicare patients. The standard cost reference range could be used to set the standard of medical insurance payment and medical quality and expense management. Conclusions Primary hospitals are mainly simple cases. There may be inefficient use and waste of medical insurance funds, which is suitable for the implementation of simple and feasible case classification techniques.