Preliminary study on inter-provincial direct settlement of outpatient expenses for patients with chronic diseases and special diseases in a cancer hospital
10.3760/cma.j.cn111325-20230518-00404
- VernacularTitle:某肿瘤医院门诊慢特病费用跨省直接结算运行情况初探
- Author:
Fan YU
1
;
Yunhe HU
;
Aidong LI
Author Information
1. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院医疗保险管理办公室，北京 100021
- Keywords:
Rate setting and review;
Outpatient chronic diseases and special diseases;
Direct settlement;
Inter-provincial medical treatment;
Outpatient expenses
- From:
Chinese Journal of Hospital Administration
2023;39(10):749-755
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the operation data of inter-provincial direct settlement of patients with chronic diseases and special diseases in outpatient service, explore the effect of policy implementation and put forward corresponding suggestions.Methods:The descriptive analysis method was used to analyze the real-time settlement data of outpatients with chronic disease and special disease of a grade A tertiary cancer hospital in Beijing in 2022, including changing trend in medical visits, age distribution of the medical population, disease distribution of the medical population, medical departments, cost structure, and payment of medical insurance benefits.Results:In 2022, the hospital admitted a total of 12 812 outpatient patients with chronic and special diseases from 28 provinces and Xinjiang Production and Construction Corps, with an increase from 53 in January to 1 957 in December. The age of the patients was 11 to 88 years old, most of whom were 51 to 70 years old. The main disease was lung cancer, and the main visiting departments were internal medicine(chemotherapy) and radiotherapy(radiotherapy). The cost of diagnosis and treatment was relatively high, and the average proportion of medical insurance fund payment was 79.94%.Conclusions:The inter-provincial direct settlement policy for outpatients with chronic diseases and special diseases could further release the demand for medical treatment, greatly reduce the economic burden of cancer patients, and help to solve the problem of " difficult and expensive medical treatment" for patients with cancer and other major diseases.
