长春市某三甲医院市医保患者住院费用分析

发布时间：2018-06-01 17:10

本文选题：住院费用 + 市医保　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:通过了解长春市市医保患者及其住院费用的基本情况、结构变动情况以及影响因素,分析影响住院费用的可能因素,探索切实有效的干预手段,为医院管理人员开展费用管理以及建立合理、高效的费用管控办法,遏制住院费用不合理增长提供切实可行的决策依据,实现医院、医疗保险管理机构和患者的三方共赢局面。方法:本研究采用文献研究法,查阅国内外关于医疗费用相关的文献与政策文件进行理论研究;运用描述性分析方法了解2013-2015年长春市某三甲医院市医保患者的性别、年龄、住院天数、支付方式、费用性质等的分布情况及其住院费用的基本情况;应用结构变动度分析住院费用结构变动情况;采用灰色关联度分析各类费用(如综合医疗服务类费用、药品类费用、诊断类费用等)与住院费用的关联程度;运用秩和检验进行单因素分析;以ln住院费用作为因变量,以年龄、性别、费用性质、人员类别和支付方式等作为自变量,采用多元线性回归分析对住院费用进行多因素分析,应用统计软件SPSS20.0对市医保患者住院费用的相关数据进行处理。结果:2013-2015年市医保住院患者人数增加,女性患者人数高于男性,且住院费用呈逐年上升趋势;45-60岁与60-75岁两组患者人数较多,60岁以上患者人数及占比逐年增加;在心内科与肿瘤中心住院的患者数量较多,与患者所患疾病中以心脑血管疾病和恶性肿瘤最多相对应;总额预付的患者人数多于其他支付方式。结构变动度分析显示,药品类人均住院费用最高,其次是综合医疗服务类,血液和血液制品类的人均住院费用最低;2013-2015年住院费用的结构变动度最大,为4.25%,2013-2014年住院费用的结构变动度最小,为2.08%,2014-2015年住院费用的结构变动度为3.32%;综合医疗服务类费用的结构变动方向在三年间都为正向变动,治疗类、药品类与血液和血液制品类在三年间均为负向变动;2013-2014年对住院费用结构变动贡献率最大的是治疗类费用,其贡献率为37.02%,2014-2015年与2013-2015年对住院费用结构变动贡献率最大的都是综合医疗服务类,分别为50.00%与50.12%。灰色关联度分析显示,各类费用与次均费用的关联度以药品类最高,其次是综合医疗服务类、治疗类、诊断类,血液和血液制品类的关联度最低。单因素分析显示,不同性别的市医保患者的住院费用差异具有显著性(p0.001);不同年龄的市医保患者间住院费用的差异具有统计学意义(p0.001);不同费用性质的市医保患者间住院费用的差异具有统计学意义(p0.001);支付方式不同,市医保患者间住院费用的差异具有统计学意义(p0.001);住院期间感染与否,引起住院费用的差异具有统计学意义(p0.001);不同住院天数的市医保患者间住院费用的差异具有统计学意义(p0.001);不同人员类别的市医保患者间住院费用的差异具有统计学意义(p0.001)。多元线性回归分析显示,支付方式、是否感染、入院情况以及年龄是患者住院费用的主要影响因素,人员类别与费用性质对住院费用的影响较小。结论:1.2013-2015年长春市某三甲医院市医保患者人数以及住院费用呈逐年上升趋势。2.住院费用逐年上升,其不合理性主要体现在药品类费用增长速度有所下降,但是在住院费用中占比最高,与住院费用的关联度也最高。同时综合医疗服务类费用与住院费用的关联度仅次于药品类费用,二者均需医务工作者以及医院管理者的关注。3.按照不同分类变量如费用性质、支付方式、入院情况、住院天数、是否感染、等分析市医保患者住院费用,发现各分类变量所引起的住院费用的差异均具有统计学意义,并且支付方式、是否感染等是对住院费用影响较大的因素。4.国家和政府应进一步深化医药卫生体制改革,明确医疗机构功能定位,推进支付制度改革,完善分级诊疗以及药品零差率政策,提高医疗保障水平,减轻患者医疗负担。在政策的指导下,医院应该变被动为主动,自觉加强内部微观管理,完善和优化医院管理规章和制度,提高医疗服务水平和诊疗质量,将合理控制医疗费用深入到临床科室,与临床绩效挂钩,激发其主动性和积极性。
[Abstract]:Objective: through understanding the basic situation of the medical insurance patients and their hospitalization expenses in Changchun City, the structural changes and the influencing factors, the possible factors affecting the hospitalization cost are analyzed, the effective and effective intervention means are explored, the cost management is carried out for the hospital administrators, and the reasonable and efficient cost management and control measures are set up to contain the incompatibility of hospitalization expenses. It provides a practical decision basis to achieve a win-win situation for three parties in hospitals, medical insurance management institutions and patients. Methods: This study uses literature research method to consult the literature and policy documents related to medical costs at home and abroad and to understand the 2013-2015 years of a three a medicine in Changchun by descriptive analysis. The distribution of the sex, age, the days of hospitalization, the way of payment, the nature of the expenses, the basic situation of the cost of hospitalization, the changes in the structural changes of the hospitalization expenses were analyzed with the structural change degree, and the various expenses (such as comprehensive medical service charge, drug cost, diagnostic cost, etc.) were analyzed with the grey correlation degree. A single factor analysis was carried out by the rank sum test; the LN hospitalization cost was used as the dependent variable, the age, sex, the cost nature, the personnel category and the way of payment were used as independent variables. The multivariate linear regression analysis was used to analyze the hospitalization expenses, and the cost of hospitalization for the medical insurance patients was applied by the statistical software SPSS20.0. Results: the number of hospitalized patients in the city increased in 2013-2015 years, the number of female patients was higher than that of men, and the cost of hospitalization was increasing year by year; the number of patients aged 45-60 years and 60-75 years old and two groups were more, the number and proportion of patients above 60 years of age increased year by year; the number of patients hospitalized in the Department of Cardiology and cancer center was more, and the patients were more than those in the hospital. The number of patients with cardiovascular and cerebrovascular diseases and malignant tumors was most appropriate; the total number of prepaid patients was more than the other modes of payment. The structural change degree analysis showed that the per capita hospitalization cost was the highest, followed by the comprehensive medical services, the lowest per capita hospitalization expenses of blood and blood products, and the structure of the 2013-2015 years of hospitalization expenses. The maximum change degree was 4.25%, and the structural change degree of hospitalization expenses was the lowest, 2.08%, and the structural change degree of the hospitalization expenses in 2014-2015 years was 3.32%. The structural change direction of the comprehensive medical service cost was positive change in the three years, the treatment class, the medicine and blood and blood products were all negative changes in three years; 2013-2014 The largest contribution rate to the structural change of hospitalization costs in the year was the treatment cost. The contribution rate was 37.02%. The largest contribution rate of the 2014-2015 and 2013-2015 years to the changes in the structure of hospitalization expenses was the comprehensive medical service class. 50% and 50.12%. grey correlation analysis respectively showed that the association between the various types of cost and the sub average cost was the highest in the drug category. The second was the comprehensive medical service class, the treatment class, the diagnosis class, the blood products and the blood products. The single factor analysis showed that the difference of hospitalization expenses of the medical insurance patients with different sex was significant (p0.001); the difference of hospitalization expenses among the medical insurance patients of different ages was statistically significant (p0.001); the different cost properties were different. The difference of hospitalization expenses among the medical insurance patients in the city was statistically significant (p0.001); the difference in the mode of payment was statistically significant (p0.001); the difference of the hospitalization expenses during the hospitalization was statistically significant (p0.001); the difference of hospitalization expenses among the medical insurance patients with different days of hospitalization was different There were statistical significance (p0.001); the difference of hospitalization costs among medical insurance patients in different categories was statistically significant (p0.001). Multiple linear regression analysis showed that payment, infection, admission, and age were the main factors affecting hospitalization expenses, and the impact of personnel category and cost nature on hospitalization costs was more than that of the patients. Conclusion: in 1.2013-2015, the number of medical insurance patients in a three a hospital in Changchun and the cost of hospitalization increased year by year, and the cost of hospitalization increased year by year. The irrational sex was mainly reflected in the decline in the rate of drug cost growth, but the ratio of hospitalization expenses was the highest, and the degree of association with hospitalization costs was the highest. At the same time, comprehensive medical treatment was also found. The relationship between the service cost and the hospitalization cost is second to the drug cost. The two parties need the attention of the medical workers and the hospital administrators to.3. according to the different classification variables such as the cost nature, the way of payment, the admission, the days of hospitalization, whether the infection, and so on, and find the hospitalization expenses caused by the various classified variables. The differences are statistically significant, and the way of payment and infection are the factors affecting the cost of hospitalization..4. countries and governments should further deepen the reform of the medical and health system, define the functional orientation of the medical institutions, promote the reform of the payment system, improve the classification and treatment as well as the policy of drug zero difference, and improve the level of medical security. Under the guidance of policy, the hospital should be passive to be passive, consciously strengthen the internal micro management, improve and optimize the hospital management rules and regulations, improve the medical service level and quality of diagnosis and treatment, the reasonable control of medical expenses to clinical departments, and clinical performance linked to stimulate their initiative and enthusiasm.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.3

【参考文献】