某三甲醫(yī)院醫(yī)保與自費(fèi)患者腦梗死住院費(fèi)用對(duì)比及影響因素研究
發(fā)布時(shí)間：2019-03-28 13:53
【摘要】：目的：本文通過對(duì)云南省某三甲醫(yī)院2007-2011年醫(yī)保與自費(fèi)患者住院費(fèi)用的相關(guān)資料進(jìn)行統(tǒng)計(jì)分析,了解醫(yī)保與自費(fèi)患者住院費(fèi)用的差異,深入了解住院費(fèi)用的構(gòu)成、變化趨勢(shì)及其影響因素,同時(shí)分析導(dǎo)致住院費(fèi)用不合理增長(zhǎng)的原因,為有效控制住院費(fèi)用提供科學(xué)依據(jù),同時(shí)也為當(dāng)?shù)蒯t(yī)藥衛(wèi)生管理部門和醫(yī)療保險(xiǎn)機(jī)構(gòu)制定單病種付費(fèi)標(biāo)準(zhǔn)提出合理的意見與建議。 方法：采用回顧性調(diào)查研究的方法。從昆明市8所三級(jí)甲等醫(yī)院里隨機(jī)選擇一所作為調(diào)查對(duì)象,收集該院2007年1月至2011年12月神經(jīng)內(nèi)科出院的所有腦梗死患者的病例,得到有效病歷2403例。以病歷首頁的基本信息為依據(jù),調(diào)查患者的社會(huì)經(jīng)濟(jì)學(xué)特征、疾病特征和診療質(zhì)量等指標(biāo),從醫(yī)院信息中心收集住院費(fèi)用的相關(guān)數(shù)據(jù)。所有資料在Epidata3.1中建立數(shù)據(jù)庫及校對(duì),數(shù)據(jù)分析使用SPSS17.0統(tǒng)計(jì)軟件,運(yùn)用描述性分析,卡方檢驗(yàn)、秩和檢驗(yàn)、相關(guān)性分析和多元回歸分析等統(tǒng)計(jì)分析方法,對(duì)獲取的資料進(jìn)行歸納、整理與分析。 結(jié)果： 1.2007-2011年醫(yī)保組與自費(fèi)組住院費(fèi)用在總體上呈上漲趨勢(shì)。 2.在住院患者總費(fèi)用上,醫(yī)保組的費(fèi)用中位數(shù)9690.66元,高于自費(fèi)組的8421.46元。經(jīng)檢驗(yàn),兩者之間差異有統(tǒng)計(jì)學(xué)意義(P0.001)。 3.藥費(fèi)和檢查費(fèi)均為醫(yī)保組與自費(fèi)組住院費(fèi)用的重要組成部分,藥費(fèi)和檢查費(fèi)的控制是有效控制住院費(fèi)用增長(zhǎng)的關(guān)鍵點(diǎn)。 4.醫(yī)保組與自費(fèi)組的平均住院天數(shù)均高于全國三級(jí)醫(yī)院12.4天的平均水平。 5.醫(yī)保組住院費(fèi)用的主要影響因素為檢查費(fèi)比例、住院天數(shù)、是否做手術(shù)、護(hù)理級(jí)別、是否使用乙類藥品和年齡等。自費(fèi)組的主要影響因素為住院天數(shù)、檢查費(fèi)比例、搶救次數(shù)、檢技比和年齡等。 值得注意的是檢查費(fèi)比例對(duì)總體住院費(fèi)用、醫(yī)保組和自費(fèi)組住院費(fèi)用的影響都較大,需進(jìn)一步深入研究。 結(jié)論： 1.應(yīng)該控制住院費(fèi)用的不合理增長(zhǎng),特別注意醫(yī)保患者住院費(fèi)用的控制。 2.醫(yī)療費(fèi)用支付方式對(duì)費(fèi)用增長(zhǎng)有影響,應(yīng)該完善醫(yī)療保險(xiǎn)制度,改善醫(yī)療費(fèi)用支付方式。 3.進(jìn)一步加強(qiáng)對(duì)藥費(fèi)和檢查費(fèi)等費(fèi)用的控制,減少過度醫(yī)療。 4.采取各種有效措施縮短無價(jià)值住院日,能有效降低住院費(fèi)用。 5.根據(jù)不同人群的費(fèi)用特點(diǎn)和影響因素,增強(qiáng)控制措施的針對(duì)性,能夠更好地保證醫(yī)保政策各項(xiàng)目標(biāo)的早日實(shí)現(xiàn)。 6.按單病種預(yù)付費(fèi)是促進(jìn)醫(yī)院科學(xué)管理、合理檢查用藥、尋找合理治療流程的有效途徑。
[Abstract]:Objective: in order to understand the difference of hospitalization cost between medical insurance and self-paid patients and the composition of hospitalization expenses, this paper makes statistical analysis on the related data of medical insurance and self-paid patients' hospitalization expenses in a tertiary first class hospital in Yunnan Province in 2007 / 2011, so as to find out the difference between medical insurance and self-paid patients' hospitalization expenses. At the same time, the causes of unreasonable increase of hospitalization expenses are analyzed to provide scientific basis for effective control of hospitalization expenses. At the same time, it also puts forward reasonable opinions and suggestions for local medical and health administration departments and medical insurance institutions to make single disease payment standard. Methods: the methods of retrospective investigation were used. 2403 cases of cerebral infarction were collected from 8 Grade 3A hospitals in Kunming from January 2007 to December 2011, and 2403 effective medical records were obtained from the patients who were discharged from the department of neurology from January 2007 to December 2011. Based on the basic information on the first page of medical records, the socio-economic characteristics, disease characteristics and diagnosis and treatment quality of the patients were investigated, and the data of hospitalization expenses were collected from the hospital information center. All the data were set up and proofread in Epidata3.1. The data analysis used SPSS17.0 statistical software, descriptive analysis, chi-square test, rank sum test, correlation analysis and multivariate regression analysis, and other statistical analysis methods, such as descriptive analysis, chi-square test, rank sum test, correlation analysis and multiple regression analysis, etc. Summarize, collate and analyze the obtained data. Results: 1. The hospitalization expenses of the medical insurance group and the self-paid group showed an increasing trend in 2007 / 2011. 2. In the total cost of inpatients, the median cost of the medical insurance group was 9690.66 yuan, which was higher than that of the self-paid group of 8421.46 yuan. The difference between the two was statistically significant (P0.001). 3. The cost of medicine and examination are both important components of the hospitalization cost of the medical insurance group and the self-expense group. The control of the drug cost and the examination fee is the key point to effectively control the increase of the hospitalization cost. 4. The average hospitalization days of the medical insurance group and the self-paid group were higher than the national average of 12.4 days in the tertiary hospitals. 5. The main influencing factors of hospitalization cost in the medical insurance group were the ratio of examination fee, the length of stay in hospital, whether to perform operation, nursing grade, use of class B drugs and age, and so on. The main influencing factors of the self-paid group were the days of hospitalization, the ratio of examination fees, the times of rescue, the ratio of inspection techniques and the age and so on. It is worth noting that the ratio of check-up fee has a great influence on the total hospitalization cost, the medical insurance group and the self-paid group, which needs to be further studied. Conclusions: 1. We should control the unreasonable increase of hospitalization expenses, pay special attention to the control of hospitalization expenses of medical insurance patients. 2. The way of payment of medical expenses has influence on the increase of expenses, so we should perfect the system of medical insurance and improve the way of payment of medical expenses. 3. Further strengthen the cost of drug and inspection control, reduce over-treatment. 4. Take all kinds of effective measures to shorten the value of hospitalization days, can effectively reduce the cost of hospitalization. 5. According to the cost characteristics and influencing factors of different groups, the pertinence of the control measures can be strengthened to ensure the early realization of the objectives of the health insurance policy. 6. Advance payment according to single disease type is an effective way to promote the scientific management of hospital, to examine and use drugs reasonably and to find a reasonable treatment flow.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R197.3;F842.684
本文編號(hào)：2448927
[Abstract]:Objective: in order to understand the difference of hospitalization cost between medical insurance and self-paid patients and the composition of hospitalization expenses, this paper makes statistical analysis on the related data of medical insurance and self-paid patients' hospitalization expenses in a tertiary first class hospital in Yunnan Province in 2007 / 2011, so as to find out the difference between medical insurance and self-paid patients' hospitalization expenses. At the same time, the causes of unreasonable increase of hospitalization expenses are analyzed to provide scientific basis for effective control of hospitalization expenses. At the same time, it also puts forward reasonable opinions and suggestions for local medical and health administration departments and medical insurance institutions to make single disease payment standard. Methods: the methods of retrospective investigation were used. 2403 cases of cerebral infarction were collected from 8 Grade 3A hospitals in Kunming from January 2007 to December 2011, and 2403 effective medical records were obtained from the patients who were discharged from the department of neurology from January 2007 to December 2011. Based on the basic information on the first page of medical records, the socio-economic characteristics, disease characteristics and diagnosis and treatment quality of the patients were investigated, and the data of hospitalization expenses were collected from the hospital information center. All the data were set up and proofread in Epidata3.1. The data analysis used SPSS17.0 statistical software, descriptive analysis, chi-square test, rank sum test, correlation analysis and multivariate regression analysis, and other statistical analysis methods, such as descriptive analysis, chi-square test, rank sum test, correlation analysis and multiple regression analysis, etc. Summarize, collate and analyze the obtained data. Results: 1. The hospitalization expenses of the medical insurance group and the self-paid group showed an increasing trend in 2007 / 2011. 2. In the total cost of inpatients, the median cost of the medical insurance group was 9690.66 yuan, which was higher than that of the self-paid group of 8421.46 yuan. The difference between the two was statistically significant (P0.001). 3. The cost of medicine and examination are both important components of the hospitalization cost of the medical insurance group and the self-expense group. The control of the drug cost and the examination fee is the key point to effectively control the increase of the hospitalization cost. 4. The average hospitalization days of the medical insurance group and the self-paid group were higher than the national average of 12.4 days in the tertiary hospitals. 5. The main influencing factors of hospitalization cost in the medical insurance group were the ratio of examination fee, the length of stay in hospital, whether to perform operation, nursing grade, use of class B drugs and age, and so on. The main influencing factors of the self-paid group were the days of hospitalization, the ratio of examination fees, the times of rescue, the ratio of inspection techniques and the age and so on. It is worth noting that the ratio of check-up fee has a great influence on the total hospitalization cost, the medical insurance group and the self-paid group, which needs to be further studied. Conclusions: 1. We should control the unreasonable increase of hospitalization expenses, pay special attention to the control of hospitalization expenses of medical insurance patients. 2. The way of payment of medical expenses has influence on the increase of expenses, so we should perfect the system of medical insurance and improve the way of payment of medical expenses. 3. Further strengthen the cost of drug and inspection control, reduce over-treatment. 4. Take all kinds of effective measures to shorten the value of hospitalization days, can effectively reduce the cost of hospitalization. 5. According to the cost characteristics and influencing factors of different groups, the pertinence of the control measures can be strengthened to ensure the early realization of the objectives of the health insurance policy. 6. Advance payment according to single disease type is an effective way to promote the scientific management of hospital, to examine and use drugs reasonably and to find a reasonable treatment flow.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R197.3;F842.684
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 張毓輝;萬泉;翟鐵民;王從從;郭鋒;魏強(qiáng);柴培培;趙郁馨;;2011年中國衛(wèi)生總費(fèi)用核算結(jié)果與分析[J];中國衛(wèi)生經(jīng)濟(jì);2013年01期
，本文編號(hào)：2448927
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