某三级医院生育保险住院费用及其影响因素分析

发布时间：2018-08-16 20:03

【摘要】：目的:分析生育保险参保人员住院分娩的医疗费用,了解影响住院分娩医疗费用的因素,研究各因素对住院医疗费用的作用强度,为生育保险的有效管理提供参考依据。方法:研究2013-2016年在山西省太原市某三级医院所有住院分娩的省直生育保险参保人员。从该医院HIS系统收集产妇的出院诊断、生育方式、有无并发症、胎数、费用等信息,并查阅医保办公室的相关报销资料作为补充。对产妇的年龄、职业、分娩方式、孕周、孕产次、病理妊娠、是否多胎妊娠、住院天数、产后并发症、住院费用明细(包含床位费、护理费、治疗费、检查费、手术麻醉费、药品费、材料费、其它费)进行统计描述,并应用单因素和多因素分析的方法分析上述各因素与住院医疗费用之间的关系。结果:1、该三级医院住院分娩医疗费用构成该三级医院住院分娩医疗费用由高到低依次为:药品费、手术麻醉费、材料费、治疗费、检查费、床位费、其它费、护理费,其中排名前三位的药品费、手术费和材料费,合计占总费用的76.78%。2、影响该三级医院住院分娩医疗费用的主要因素单因素分析显示高龄组的平均住院分娩医疗费用高于其它年龄组,剖宫产组高于难产分娩组、人工干预分娩组和自然分娩组,初产妇组低于经产妇组,病理妊娠组高于正常妊娠组,多胎妊娠组高于单胎妊娠组,有产后并发症产妇组高于无并发症产妇组,住院天数越多费用越高。不同职业、不同孕龄产妇平均住院费用没有差异。多因素分析显示对住院分娩医疗费用的主要影响因素有产后并发症、分娩方式、病理妊娠、住院天数和年龄。3、该三级医院生育保险定额结算情况自然分娩组平均结余费用为162.61元,结余比例为6.25%;人工干预分娩组平均结余费用为121.97元,结余比例为4.69%;剖宫产组的平均结余费用为136.32元,结余比例为2.96%;难产分娩组平均超支费用为507.28元,超支比例为17.89%。结论:该三级医院住院分娩医疗费用由高到低依次为:药品费、手术麻醉费、材料费、治疗费、检查费、床位费、其它费、护理费。影响住院分娩医疗费用的主要因素有产后并发症、分娩方式、病理妊娠、住院天数和年龄。该三级医院的生育住院医疗费用定额结算略有结余。
[Abstract]:Objective: to analyze the medical cost of in-hospital delivery of maternity insurance personnel, to understand the factors influencing the medical expenses of in-patient childbirth, to study the effect of each factor on the medical expenses of hospitalization, and to provide a reference for the effective management of maternity insurance. Methods: in 2013-2016, the insured persons of provincial straight birth insurance in a third class hospital in Taiyuan, Shanxi Province were studied. The HIS system was used to collect the information of discharge diagnosis, birth style, complications, number of births, expenses and so on from the hospital, and the related reimbursement data of the medical insurance office were consulted as a supplement. Age, occupation, mode of delivery, gestational week, pregnancy, pathological pregnancy, multiple pregnancy, hospitalization days, postpartum complications, hospitalization expenses (including bed fee, nursing fee, treatment fee, examination fee, operation anaesthesia fee, etc.) The cost of drugs, materials and other expenses were described statistically, and the relationship between the above factors and the medical expenses of hospital was analyzed by single factor analysis and multivariate analysis. Results: 1. The medical expenses of hospital delivery in the third level hospital are: drug cost, operation anaesthesia cost, material cost, treatment fee, examination fee, bed fee, other fee, nursing fee, etc. The cost of drugs, operating expenses and materials, which accounted for 76.78.2% of the total cost, were among the top three. The single factor analysis showed that the average medical cost of in-patient delivery in the elderly group was higher than that in the other age groups, and the single factor analysis showed that the average medical cost of in-hospital delivery was higher in the elderly group than in the other age groups. Cesarean section group was higher than difficult delivery group, artificial intervention group and natural delivery group, primiparous group was lower than transpartum group, pathological pregnancy group was higher than normal pregnancy group, multiple pregnancy group was higher than single pregnancy group. The postpartum complications group was higher than the non-complication group, and the more days of hospitalization, the higher the cost. There was no difference in average hospitalization expenses among different occupations and different gestational ages. Multivariate analysis showed that the main factors affecting medical expenses of hospitalized delivery were postpartum complications, delivery mode, pathological pregnancy, The average balance cost of the natural delivery group was 162.61 yuan, the balance ratio was 6.25 yuan, and the average balance cost of the artificial intervention delivery group was 121.97 yuan. The average cost of caesarean section was 136.32 yuan, the proportion of surplus was 2.96 yuan, the average cost of overspending was 507.28 yuan, the proportion of overspending was 17.89 yuan. Conclusion: the order of medical expenses of the hospital is: drug cost, operation anaesthesia cost, material cost, treatment fee, examination fee, bed fee, other fee, nursing fee. The main factors affecting medical expenses of hospitalized delivery were postpartum complications, delivery mode, pathological pregnancy, hospitalization days and age. The three-level hospital maternity hospitalization fee quota settlement slightly balance.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.32

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