目的 随着全国医疗保障跨省异地就医直接结算政策的推进,通过对医疗机构异地就医患者住院医疗费用、就诊情况的分析,为完善异地就医医保结算政策提供建议。方法 本文对江苏省某三甲医院异地就医医保患者住院医疗费用进行分析,利用SPSS24.0探究患者年龄、性别、住院天数、费用结构等因素对住院医疗费用的影响。结果 相较于其他身份的医保患者,异地就医医保患者由于年龄、住院天数、病种特征等差异,医疗资源消耗较大。结论 建议进一步提升医保统筹层次,提高共济能力;持续探索异地就医医保同病同价支付原则,提高制度普惠性;构建国家统一医保信息智能审核平台,推动医院医保基金管理精细化。

Objective: With the promotion of the national medical security policy of direct settlement of transprovincial medical treatment, the paper puts forward suggestions for improving the policy through the analysis of the inpatient medical expenses, treatment situation of transprovincial patients. Methods: In this paper, the inpatient expenses of ecdemic patients in a first-class hospital in Jiangsu Province were analyzed, SPSS24.0was used to explore the influence of the patient's age, gender, length of stay, cost structure, other factors on the inpatient expenses. Results: Compared with medical insurance patients with other identities, the hospitalization resource consumption of medical insurance patients in different places was larger due to the differences in age, length of stay, characteristics of diseases. Conclusion: It is suggested to further enhance the level of medical insurance pooling, improve mutual aid ability. We will continue to explore the principle of the same price for the same disease, improve the system's universality. Also, we should build a unified national medical insurance information intelligent audit platform, promote the fine management of hospital medical insurance funds