THANH TOÁN CHI PHÍ BẢO HIỂM Y TẾ VÀ MỨC HỖ TRỢ NGƯỜI BỆNH ĐƯỢC ĐIỀU TRỊ NỘI TRÚ DIỆN ĐA TUYẾN TẠI BỆNH VIỆN ĐA KHOA TỈNH KIÊN GIANG TRONG 6 THÁNG, NĂM 2020

Abstract

The study used the health insurance payment database for 6 months of 2020 of 34,792 patients with multi-level health insurance at the General Hospital of Kien Giang province. Research objectives: (1) Describe health insurance payment levels according to groups of health insurance card holders (2) Analyze the structure of expenses, benefit levels of patients and some related factors. Research method: Retrospective statistics on official health insurance payments of the hospital, using descriptive calculations: mean, median, mode of expenditure levels, applying non-parametric and analytical test covariance (ANCOVA) to control confounding factors when comparing averages.
Results: Average health insurance payment was 8,167 thousand VND/inpatient treatment session; 50% below the level of 3,165 thousand VND, there were different groups of health insurance cards, ranging from 8,525 to 4,592 thousand VND/inpatient treatment session, with an average of 1,444 thousand per day, ranging from 641 thousand to 1,511 thousand VND. The difference between age, diseases and sex groups was statistically significant, p <0.001 The structure of spending for bed accounted for the highest proportion of 30.91%, followed by drug costs at 18.15%, laboratory tests accounting for 16.83%, the transporting fees at roughly 0%. Patients had to spend up to 18.8% of total payments for extra services and out-of-list medical supplies and drugs. The support level of health insurance was very large, accounting for 86.16%, the patient’s out- of-pocket expenses accounted for 13.84%. Those in the priority groups had a lower out-of-pocket expense ratio than the general level (5.9% vs. 13.84%). Conclusions: The average total payment is 8,167 thousand VND/session. Payment for patient’s bed accounted for the highest percentage.
Benefit from health insurance was 86%. Priority groups had lower out-of-pocket expenses than others. Age, group of health insurance card holders and group of diseases by wards were the main factors identified.