原发性肝癌手术病人住院费用与医疗保险支付管理探索

发布时间：2018-06-26 22:50

本文选题：原发性肝癌 + 结构分析　；参考：《东南大学》2017年硕士论文

【摘要】：目的:了解2014、2016、2016三年间南京市某三甲医院原发性肝癌首次住院手术患者基本情况以及3年内住院诊疗总费用的变化趋势;本文运用新灰色关联分析法和结构变动分析法等分析原发性肝癌住院手术患者诊疗总费用的内部影响因素,描述各费用项目与诊疗总费用之间的关联及其密切程度,并对其影响力的大小进行排序;通过统计分析对影响住院患者诊疗总费用的外部因素进行筛选,提取出有意义的变量并进行多重线性回归分析,指出医疗费用增长中的可控因素;同时利用分类回归树算法,尝试进行病例分组和合理费用测算,为病种模型的建立提供一定的方法学的参考,并为合理控制住院费用增长、保障医保基金安全运行、减轻病人疾病负担提供科学的建设意见。方法:本研究中选择南京市某三甲医院2014、2015、2016三年间原发性肝癌首次住院手术病人的住院期间费用明细和出院病案首页部分信息两部分资料作为研究样本资料,经过严格准入及对异常信息的整理得到合理有效样本数为912例。根据物价指数CPI的涨幅和变动,选择基线后对诊疗费用进行合理调整,分析原发性肝癌住院手术患者诊疗费用的整体情况,分析住院诊疗总费用的内部结构、内部影响因素以及外部影响因素;然后,在原发性肝癌住院手术病人的诊疗费用影响因素的分析和前期所进行的文献研究,在借鉴国际上肿瘤类重大疾病支付管理的实践和经验基础上,应用决策树中分类回归树的算法建立初步的病例组合模型,并探讨DRGs支付方式的合理性,尝试制定出不同病组按病种付费的科学标准。结果:1、原发性肝癌住院手术病人平均人次费用为60310.59元,占该医院原发性肝癌住院病人总费用中最高费用的类目依次为西药类、耗材类、诊断类和手术治疗类,其中西药费最高,约占总费用的40%。2、新灰色关联分析中发现,西药费的关联度最大,其次为耗材类费用以及诊断类费用。结构变动度分析中则提示,住院诊疗总费用的变化主要有诊断费、耗材类、西药类费用引起,最高时三者合计贡献率超过80%。3、住院费用受年龄、性别、合并症、入院方式、住院天数、是否医保患者、临床分型分期等多种因素的影响;4、采用决策树算法中分类回归树的方法将病例分别分组,无论从统计学的方法上,还是在临床的具体实践中,都具有较为合理的实际意义,结果可读性较强;各组别得出的具体费用标准,可以为医保决策机构提供相关支付标准制定的依据。建议:1、当前原发性肝癌住院手术病人费用管理问题的根本,是要解决其缺乏规范化治疗的问题,需要完善临床路径设计,推动疾病诊断和治疗的合理化、规范化,提升重大疾病的诊疗水平和效果。2、探索建立合理的以DRGs为核心的新的医保支付方式,推动肿瘤疾病支付制度的建立和完善,同时完善医疗卫生服务系统的信息化建设,为政策实践和学术研究提供科学的依据,也为推进支付方式改革提供畅通的渠道。3、通过合理控制本研究中统计分析所指出的影响因素,合理控制医疗卫生服务费用的增长,以保证服务质量为前提,同时注意防范道德风险。4、针对肿瘤疾病患者外购分子靶向药物的情况,一方面要加速医保谈判,将合理需求纳入医保药品目录范围,减轻患者疾病负担,另一方面要正确引导患者的需求,避免盲目跟风,合理选择治疗方案。5、肝癌早发现、早诊断、早治疗工作刻不容缓。
[Abstract]:Objective: to understand the basic situation of the first hospitalized patients with primary liver cancer in a three a hospital of Nanjing in 201420162016 and three, and the change trend of the total cost of hospitalization in 3 years. In this paper, the internal influence factors of the total cost of diagnosis and treatment for patients with primary liver cancer were analyzed by the new grey correlation analysis and structural change analysis. The relationship between the cost items and the total cost of diagnosis and treatment is described and the size of their influence is sorted. The external factors affecting the total cost of diagnosis and treatment in hospitalized patients are screened by statistical analysis, the meaningful variables are extracted and the multiple linear regression analysis is carried out, and the controllable factors in the growth of medical expenses are pointed out. At the same time, using the classification regression tree algorithm, try to carry out case grouping and reasonable cost calculation, provide a certain reference for the establishment of the disease model, and provide scientific advice for the rational control of the growth of hospitalization expenses, ensuring the safe operation of the medical insurance fund and alleviated the disease burden of the patients. Method: This study selected a three of Nanjing city. A hospital for the first time of 201420152016 three years of primary liver cancer for the first time in the hospital for the first time the cost of the hospital and the first page of the medical record part of the information two part of the data as the research sample data, after strict access and the arrangement of abnormal information to get reasonable and effective samples of 912 cases. According to the price index CPI increase and change, choose After a reasonable adjustment of the cost of diagnosis and treatment, the overall situation of the cost of diagnosis and treatment of the patients with primary liver cancer was analyzed, the internal structure of the total cost of hospitalization, the internal influence factors and the external factors were analyzed. On the basis of the practice and experience of international cancer disease payment management, a preliminary case combination model was established by using the algorithm of classified regression tree in the decision tree, and the rationality of the DRGs payment method was discussed. The scientific standards for the payment of disease types in different groups were made. Results: 1, primary liver cancer hospitalization operation. The average cost of the patient was 60310.59 yuan. The highest cost of the total cost of the primary liver cancer in the hospital was the western medicine, the consumables, the diagnosis and the surgical treatment, among which Western medicine was the highest, accounting for 40%.2 of the total cost, the new grey correlation analysis was found, the association of Western medicine was the largest, and the second was the cost of consumables. In the structural change degree analysis, the changes of the total cost of the hospital diagnosis and treatment were mainly the diagnosis fee, the consumables and the western medicine. The total contribution rate of the three persons was more than 80%.3, and the hospitalization expenses were affected by age, sex, complication, hospitalization days, medical insurance patients, clinical classification stages and many other factors. 4, using the method of classification regression tree in the decision tree algorithm, the cases are divided into two groups, both in statistical methods and in clinical practice, which have more reasonable practical significance and more readable results. The specific cost standards of each group can provide relevant payment standards for medical insurance policy making institutions. 1. The root of the cost management of the patients with primary liver cancer is to solve the problem of the lack of standardized treatment. It is necessary to improve the clinical path design, promote the rationalization and standardization of the diagnosis and treatment of the disease, improve the level and effect of the diagnosis and treatment of the major diseases.2, and explore the establishment of a reasonable DRGs core. The new payment method of medical insurance promotes the establishment and perfection of the payment system for cancer diseases, and improves the information construction of the medical and health service system, provides scientific basis for the policy practice and academic research, and provides a smooth channel for the reform of the payment mode of.3. In order to control the growth of medical and health service cost reasonably, in order to ensure the quality of service as the premise, and guard against the moral risk.4, on the one hand, the medical insurance negotiations should be accelerated and the reasonable demand should be incorporated into the range of medical insurance drugs to reduce the disease burden on the patients. On the other hand, it should be correctly cited. To guide the needs of patients, avoid blindly following the trend, and rationally choose treatment plan.5, early detection, early diagnosis and early treatment of liver cancer is urgent.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;F842.684

【参考文献】