目的: 分析农村参保人群跨省就医直接结算的就医流向、病种、费用等特征,了解不同备案类型人群差异。方法: 以海南省为例,抽取2017年-2019年全省新型农村合作医疗跨省就医直接结算数据进行描述性分析,采用Kruskal Wallis H检验及卡方检验对不同备案类型人群费用及病种差异进行分析。结果: 海南省跨省就医农村参保人群呈现流入地区集中、大病转诊为主、肿瘤患者占比较多等特征,其中大病转诊患者的住院费用、医保支付费用及医保报销比例均高于长期异地居住及长期异地工作患者（p<0.05）,而长期异地居住及长期异地工作患者差异较小;同时,不同病种组别中各种备案类型人员占比也有显著差异,肿瘤病组中80.6%为大病转诊患者,消化系统疾病、肌肉骨骼和结缔组织疾病以及循环系统疾病组中近50%为异地长期工作人员,呼吸系统、眼科以及先天性疾病组中近半数为异地长期居住人员,体现了不同跨省就医人群差异化的医疗服务需求。讨论与建议： 针对不同类型异地就医农民群体应结合其群体特征进行分类管理,对于长期异地居住或工作的农民群体,流入地区应制定配套的医疗、教育、职业、公共服务制度体系,保障其权益,流出地区应加强本地医疗服务体系建设,提高医疗卫生服务水平,政府相关部门可以备案制度为抓手,核实患者就医类型和待遇,提高精细化管理水平,保障医保基金合理利用。

Objective: To analyze the characteristics of medical treatment flow, disease types, expenses and other characteristics of cross-provincial medical direct settlement of rural insured population, and to understand the differences between different record types. Methods: Extract and descriptively analyze the direct settlement data of new rural cooperative medical care in Hainan Province from 2017 to 2019. The Kruskal Wallis H non-parametric test and Chi-square test are used to test the differences in the expenses and disease types of different record types. Results: The cross-provincial rural insured population in Hainan Province showed the characteristics of concentrated inflow areas, major referrals for serious diseases, and a large proportion of cancer patients. The hospitalization expenses, medical insurance payment expenses and medical insurance reimbursement ratios of patients referred for serious diseases were higher than those of patients who lived and worked in different places for a long time (p<0.05), while the difference between patients who lived and worked in different places for a long time was smaller. Discussion and suggestions: Different types of cross-provincial peasant groups seeking medical treatment should be managed by classification. For peasant groups who live or work in different places for a long time, the inflow areas should formulate supporting medical, educational, vocational, and public service systems to protect their rights and interests. Outflow areas should strengthen the construction of local medical service system and improve the level of medical and health services At this stage, relevant government departments should take the record policy as the point to verify the type and treatment of patients, improve the level of refined management, and ensure the rational use of funds.