终末期肾病血液透析和腹膜透析疾病经济负担及影响因素

发布时间：2018-05-13 03:01

本文选题：终末期肾病 + 血液透析　；参考：《郑州大学》2017年硕士论文

【摘要】：目的本研究调查河南省、湖北省、湖南省、辽宁省、浙江省、江苏省六省41家医院,6008例终末期肾病血液透析和腹膜透析患者的基本情况、透析方式及透析费用等,测算疾病直接经济负担和间接经济负担,分析其疾病经济负担的影响因素,以期能够通过建议采用科学适宜的透析方式,最大限度地减轻其经济负担,避免“因病致贫、因病返贫”的发生,改善终末期肾病患者的生活质量,帮助他们尽早回归社会,为卫生政策决策者制定相关政策提供依据和建议。方法采用现场问卷调查的方法,对血液透析和腹膜透析患者进行回顾性调查,同时查阅病历资料丰富调查内容。调查内容包括:人口社会学特征(患者性别、年龄、婚姻状况、文化程度等),医疗费用情况(透析费用、肾病药品费、化验费用、住院费用、自付费用、医保报销费用等)。本研究使用Epidata 3.1建立数据库,进行数据的双录入,运用SPSS 21.0进行统计分析。结果(1)年龄组对比分析中,经χ2检验,差异有统计学意义(P0.001)。血液透析患者年龄集中在50岁至69岁,占比为46.2%,患病人数随年龄的增加呈现递增趋势,70岁以后患病人数减少。腹膜透析患者年龄集中在40岁至59岁,占比为51.2%。(2)原发病因对比分析中,经χ2检验,差异无统计学意义(P=0.375)。原发病因前三顺位分别是:慢性肾小球肾炎(39.6%)、糖尿病肾病(16.4%)、高血压性肾病(14.2%)。血透原发病因依次是:慢性肾小球肾炎、高血压性肾病和糖尿病肾病,腹透原发病因依次是:慢性肾小球肾炎、糖尿病肾病和高血压性肾病。(3)参保情况分析中,经χ2检验,差异有统计学意义(P0.001)。血透患者参加基本医疗保障的占比为93.83%,腹透患者参加基本医疗保障的占比为98.88%,其中参加城镇职工基本医疗保险的血透患者多于腹透患者,参加新型农村合作医疗的血透患者少于腹透患者。(4)疾病经济负担对比分析中,经秩和检验,差异有统计学意义(P0.001)。直接疾病经济负担血液透析人均102000元,腹膜透析人均72400元;间接疾病经济负担血液透析为649627元,腹透患者为634167元。血透均高于腹透。(5)在透析患者家庭经济负担对比分析中,经秩和检验,差异有统计学意义(P0.001)。血透在自付费用、医保报销费用、借债支付费用、社会救助费用等方面均值高于腹透。(6)不同省份、不同级别医院直接经济负担对比分析中,河南省、湖北省、湖南省的直接经济负担高于浙江省、江苏省、辽宁省,从透析方式看,各省血透直接经济负担均高于腹透,且差距明显。三级医院血液透析费用为108022元,腹透患者为71929元,血透与腹透费用比例约为1:1.5。结论(1)终末期肾病患者的直接经济负担和间接经济负担腹膜透析均低于血液透析,血液透析患者人均直接经济负担为102000元,间接经济负担为649627元,腹膜透析患者人均直接经济负担为72400元,间接经济负担为634167元。血液透析经济负担的主要影响因素为就医医院级别;腹膜透析经济负担的主要影响因素为医保类型。(2)血液透析疾病经济负担浙江省、江苏省医保报销比例高于且自付比例低于河南省、湖北省、湖南省和辽宁省。腹膜透析疾病经济负担浙江省、湖南省医保报销比例高于其他省份,浙江省、河南省自付比例低于其他省份。医保报销比例及自付比例受到经济发展水平的影响。(3)随着我国老龄化进程加快,终末期肾病的老年发病人口群体大,患病人口趋于年轻化、低龄化,为切实减轻透析患者、医保部门及全社会的疾病经济负担,就目前我国国情来看推广腹透更具有现实意义,也更具有卫生经济学意义。
[Abstract]:Objective to investigate 41 hospitals in six provinces of Henan, Hubei, Hunan, Liaoning, Zhejiang and Jiangsu, 6008 patients with end-stage renal disease, hemodialysis and peritoneal dialysis, to calculate the direct economic burden and indirect economic burden of the disease, and to analyze the factors affecting the economic burden of the disease. Through the suggestion of adopting a scientific and appropriate dialysis method, it can reduce its economic burden to the maximum extent, avoid the occurrence of "illness due to poverty and return to poverty", improve the quality of life of the patients with end-stage kidney disease, help them return to the society as soon as possible, and provide the basis and suggestions for the policy makers to formulate relevant policies. A retrospective survey of patients in hemodialysis and peritoneal dialysis was carried out in volume. The contents of the survey included the demographic characteristics of the population (gender, age, marital status, educational level, etc.), medical expenses (dialysis costs, nephrotic drug fees, laboratory costs, hospitalization costs, and self payment). This study used Epidata 3.1 to establish a database, double entry of data, and use SPSS 21 for statistical analysis. Results (1) in the age group comparison analysis, the difference was statistically significant (P0.001). The age of hemodialysis patients was from 50 to 69 years, accounting for 46.2%, and the number of patients was increased with age. The increasing trend was to decrease the number of patients after 70 years of age. The age of peritoneal dialysis patients was from 40 to 59 years old, and the proportion of 51.2%. (2) was compared. The difference was not statistically significant (P=0.375) by the chi 2 test. The first three cases were chronic glomerulonephritis (39.6%), diabetic nephropathy (16.4%), and hypertensive nephropathy (14.2%). The primary causes of hemodialysis were chronic glomerulonephritis, hypertensive nephropathy and diabetic nephropathy. The primary causes of peritoneal dialysis were chronic glomerulonephritis, diabetic nephropathy and hypertensive nephropathy. (3) the analysis of the insured conditions, the difference was statistically significant (P0.001). The proportion of patients with hemodialysis in basic medical security was 93.83%. The proportion of the patients who participated in the basic medical security was 98.88%, and the hemodialysis patients who participated in the basic medical insurance of the urban workers were more than those of the peritoneal dialysis. The patients who participated in the new rural cooperative medical treatment were less than those of the peritoneal dialysis. (4) in the comparative analysis of the economic burden of the disease, the difference was statistically significant (P0.001). 102000 yuan per capita for hemodialysis and 72400 yuan per capita in peritoneal dialysis, 649627 yuan for the economic burden of indirect disease and 634167 yuan for peritoneal dialysis. (5) in the comparative analysis of the family economic burden of dialysis patients, the difference has the significance of unified planning (P0.001) by rank sum test. The cost of blood dialysis at the expense of self payment and the reimbursement fee for medical insurance In different provinces, the direct economic burden of Henan Province, Hubei province and Hunan province is higher than that of Zhejiang, Jiangsu and Liaoning. The direct economic burdens of the provinces of Zhejiang, Jiangsu and Liaoning are higher than those of the peritoneal dialysis, and the difference between the direct economic burdens of all provinces is higher than that of the peritoneal dialysis, and the gap between the provinces is higher than that of the abdominal penetration. The cost of hemodialysis in the three level hospital was 108022 yuan, the peritoneal dialysis patient was 71929 yuan, the ratio of blood dialysis and peritoneal dialysis was about 1:1.5. conclusion (1) the direct economic burden and indirect economic burden of peritoneal dialysis in patients with end-stage renal disease were lower than those of hemodialysis. The direct economic burden of patients in hemodialysis patients was 102000 yuan, and the indirect economic burden was 6496. 27 yuan, the direct economic burden of the patients in peritoneal dialysis was 72400 yuan per capita and the indirect economic burden was 634167 yuan. The main influencing factors of the economic burden of hemodialysis were medical hospital level, the main influencing factor of the economic burden of peritoneal dialysis was the medical insurance type. (2) the burden of medical insurance for hemodialysis diseases was higher than that of Zhejiang Province, and the proportion of medical insurance reimbursement in Jiangsu province was higher than that of the medical insurance. The proportion of self payment is lower than that of Henan, Hubei, Hunan and Liaoning. The economic burden of peritoneal dialysis in Zhejiang Province, the proportion of medical insurance reimbursement in Hunan province is higher than that of other provinces, Zhejiang province and Henan province are lower than the other provinces. The proportion of medical insurance reimbursement and the proportion of self payment are influenced by the economic development level. (3) along with the accelerated aging process in China The population of the elderly with end-stage renal disease is large, the population of the disease tends to be younger, and the age of the disease is reduced. The economic burden of the medical insurance department and the whole society will be more practical, and it is of more significance to popularize the peritoneal dialysis in our country.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5;R197.1

【参考文献】