| 李 军,马 雷,柳俊杰.873例次天津市儿童肿瘤住院患者医保支付费用分析[J].中国肿瘤,2019,28(9):667-671. |
| 873例次天津市儿童肿瘤住院患者医保支付费用分析 |
| Analysis of Medical Expenses and Insurance Reimbursement for Children with Tumors in Tianjin City |
| 投稿时间：2019-06-28 |
| DOI：10.11735/j.issn.1004-0242.2019.09.A006 |
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| 中文关键词: 儿童肿瘤 医保费用 天津 |
| 英文关键词:amily of patients. |
| 基金项目:教育部人文社会科学研究规划基金(16YJA630024) |
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| 中文摘要: |
| 摘 要：［目的］ 对住院儿童肿瘤患者进行医保支付费用的分析，为医院加强控费管理和儿童大病患者医保政策的优化提供依据。［方法］ 以天津市肿瘤医院儿童肿瘤科2014至2018年诊断为恶性肿瘤的873例次住院医保患者为研究对象，利用SPSS 19.0统计软件，分析患者基本情况、病种构成、诊治特点与住院费用、医保支付费用的关系。［结果］ 873例次儿童肿瘤患者男童多于女童。恶性淋巴瘤、肾母细胞瘤、横纹肌肉瘤为前3位诊治病种，占51.77%。手术治疗和内科治疗为主要治疗方式。平均住院日、次均发生费用和次均医保支付费用均呈下降趋势。住院费用构成中药品费所占比例最高，在30%以上。医保报销后患者个人负担仍较大。［结论］ 儿童肿瘤治疗周期较长，关键有效治疗手段的医保支付比例偏低，致使总体医保费用支持不足，患者家庭负担较重。提高儿童肿瘤患者治疗的医保支付比例、扩大儿童恶性肿瘤支付项目的限定范围或引入商业保险作为补充是将来发展的主要方向。 |
| 英文摘要: |
| Abstract：［Purpose］ To analysis of medical expenses and insurance reimbursement for children with tumors. ［Methods］ Medical expenses of 873 pediatric patients diagnosed as malignant tumors in Children’s Oncology Department of Tianjin Cancer Hospital from 2014 to 2018 were analyzed. The relationship of total medical expenses and insurance reimbursement with the disease types，and the methods of diagnosis and treatment was analyzed. ［Results］ In the 873 children with tumors，there were 602 boys and 271 girls. Malignant lymphoma，nephroblastoma and rhabdomyosarcoma were three most common types of cancer，accounting for 51.77% of all malignancies. Surgery and medical therapy were the main treatment methods. The average length of hospital stay，average expenses and average insurance reimbursement showed downward trend from 2014 to 2108. The proportion of drug expenses in total medical costs was the highest，accounting more than 30%. After insurance reimbursement，the personal burden was still heavy. ［Conclusion］ The proportion of insurance reimbursement in total medical costs for children with malignancies is relatively low in Tianjin city，which result in the heavy economic burden for family of patients. |
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