目的: 探索居民医保患者医疗费用控制的有效措施。方法: 基于政策文献剖析,分析2008年—2020年居民医保患者的门诊、住院总费用和均次费用趋势及住院费用构成等。结果: 普陀区居民医保患者门诊、住院总费用年均增长率均高于同期上海市居民人均可支配收入增长率。居民医保患者住院总费用增长率高于门诊,其中民办医院居民医保医疗费用较公立医院增长更快,住院费用中增长较快的项目是手术材料费和治疗费。结论: 普陀区居民医保控费压力较大。建议通过支付方式改革提升医保基金的使用效率,同时加强监管,保证医保基金的合理使用。

Objective: The paper is to explore effective methods and measures for managing URBMI expenses. Methods: Based on the analysis of policy literature, the medical insurance reimbursement database is used to analyze the trends in total and per-visit URBMI outpatient and inpatient expenses and the composition of inpatient expenses in 2008-2020. Results: The average annual growth rate of total URBMI outpatient and inpatient expenses in Putuo District of Shanghai is higher than that of per-capita disposable income of Shanghai residents over the same period. Total URBMI inpatient expenses grew faster than total URBMI outpatient expenses. Private hospitals saw URBMI expenses growing faster than public hospitals. Of inpatient expenses, surgical supply costs and treatment expenses grew faster. Conclusion: The total medical expenses of URBMI beneficiaries in Putuo District of Shanghai are increasing rapidly, posing great pressure to expense control. It is necessary to strengthen expense controls and supervision in terms of payment methods to ensure the rational use of medical insurance funds.