上海市儿童医疗服务利用和费用分析OA

Objective To comprehensively analyze pediatric healthcare utilization and health expenditure in Shanghai,identify existing problems and provide evidence-based recommendations for optimizing the multi-level pediatric health insurance system.Methods Multi-source data on the utilization and costs of children's medical services in Shanghai from 2018 to 2023 were collected.Descriptive statistical analysis was used to analyze the number of children's visits,the out-of-pocket ratio for outpatient and hospitalization,and the cost of disease types.Multivariate linear regression analysis was used to analyze the influencing factors of the out-of-pocket ratio for hospitalization expenses.Results Children tend to visit tertiary hospitals in Shanghai(in 2022,the proportion of outpatient visits of children in tertiary hospitals was 61.00%,and the proportion of hospitalization was 88.00%).The level of hospitalization insurance is much higher than that of outpatient(in 2023,the out-of-pocket ratio for hospitalization was 35.76%,and the out-of-pocket ratio for outpatient was 64.33%).There are differences in insurance among different disease types,with the out-of-pocket ratio for pneumonia being 28.45%,and the out-of-pocket ratio for osteosarcoma in rare diseases reaching 73.41%.The influencing factors of children had a higher out-of-pocket ratio were visiting tertiary hospitals,not participating in the"double insurance",sufferring from rare diseases,and high-burden diseases(P＜0.05).Conclusion Shanghai children's healthcare system fac es structural deficiencies,such as unequal service tier distribution,imbalanced outpatient-inpatient benefits,and inadequate rare disease coverage,we should actively promote pediatric hierarchical diagnosis and treatment,optimize the reimbursement treatment for outpatient,appropriately expand the coverage of supplementary medical insurance,to meet the multi-level medical insurance needs,and further improve the health level of children.