某三甲医院医保与自费患者脑梗死住院费用对比及影响因素研究
发布时间：2019-03-28 13:53
【摘要】：目的：本文通过对云南省某三甲医院2007-2011年医保与自费患者住院费用的相关资料进行统计分析,了解医保与自费患者住院费用的差异,深入了解住院费用的构成、变化趋势及其影响因素,同时分析导致住院费用不合理增长的原因,为有效控制住院费用提供科学依据,同时也为当地医药卫生管理部门和医疗保险机构制定单病种付费标准提出合理的意见与建议。 方法：采用回顾性调查研究的方法。从昆明市8所三级甲等医院里随机选择一所作为调查对象,收集该院2007年1月至2011年12月神经内科出院的所有脑梗死患者的病例,得到有效病历2403例。以病历首页的基本信息为依据,调查患者的社会经济学特征、疾病特征和诊疗质量等指标,从医院信息中心收集住院费用的相关数据。所有资料在Epidata3.1中建立数据库及校对,数据分析使用SPSS17.0统计软件,运用描述性分析,卡方检验、秩和检验、相关性分析和多元回归分析等统计分析方法,对获取的资料进行归纳、整理与分析。 结果： 1.2007-2011年医保组与自费组住院费用在总体上呈上涨趋势。 2.在住院患者总费用上,医保组的费用中位数9690.66元,高于自费组的8421.46元。经检验,两者之间差异有统计学意义(P0.001)。 3.药费和检查费均为医保组与自费组住院费用的重要组成部分,药费和检查费的控制是有效控制住院费用增长的关键点。 4.医保组与自费组的平均住院天数均高于全国三级医院12.4天的平均水平。 5.医保组住院费用的主要影响因素为检查费比例、住院天数、是否做手术、护理级别、是否使用乙类药品和年龄等。自费组的主要影响因素为住院天数、检查费比例、抢救次数、检技比和年龄等。 值得注意的是检查费比例对总体住院费用、医保组和自费组住院费用的影响都较大,需进一步深入研究。 结论： 1.应该控制住院费用的不合理增长,特别注意医保患者住院费用的控制。 2.医疗费用支付方式对费用增长有影响,应该完善医疗保险制度,改善医疗费用支付方式。 3.进一步加强对药费和检查费等费用的控制,减少过度医疗。 4.采取各种有效措施缩短无价值住院日,能有效降低住院费用。 5.根据不同人群的费用特点和影响因素,增强控制措施的针对性,能够更好地保证医保政策各项目标的早日实现。 6.按单病种预付费是促进医院科学管理、合理检查用药、寻找合理治疗流程的有效途径。
[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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.3;F842.684
本文编号：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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.3;F842.684
【参考文献】
相关期刊论文 前1条
1 张毓辉;万泉;翟铁民;王从从;郭锋;魏强;柴培培;赵郁馨;;2011年中国卫生总费用核算结果与分析[J];中国卫生经济;2013年01期
，本文编号：2448927
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