Diseases distribution and data analysis of children patients with allopatry direct settlement of medical insurance / 中华医院管理杂志

ABSTRACT

Objective To research the performance of direct settlement for allopatry medical insurance at a tertiary specialized children′s hospital in Beijing, and to analyze the basics of these inpatients and the structural characteristics of their diseases, for basis and suggestions for improving the policy of direct settlement of allopatry medical insurance. Methods A statistical description of direct settlement data was made for allopatry medical insurance at this hospital from August 2017 to July 2018, to study the age, hometown, attribute, distribution of inpatient departments and disease distribution of these children. Results The patients mainly came upon referrals, preschool children in most cases. The average daily hospitalization cost of the disease was high relatively, and the number of hospitalizations was high as well. Compared with children inpatients in Beijing, these patients tend to come for surgical treatment for malignant tumors and congenital diseases.Conclusions The allopatry direct settlement of children′s medical insurance settlement is found mostly with diseases those are complicated and severe. The management of such settlement can be improved by cooperating with their local institutions in advance, data checking in the course, simplifying the formalities for special diseases, and the differential reimbursement ratio for these patients.