不同并发症对天津市参保2型糖尿病患者住院费用影响的分析

发布时间：2018-01-29 12:42

本文关键词： 居民职工 2型糖尿病住院费用并发症多元线性回归结构方程模型　出处：《天津医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:整理天津市2010-2014年医疗保险数据库中2型糖尿病患者住院资料,认识糖尿病患者的基本信息和住院情况,分析患者并发症的数目和类型,住院费用的组成,进而研究费用的变化走向,以及影响因素,为降低糖尿病患者的住院费用和医疗保险政策的制定提供理论支持,进而为我国今后糖尿病患者的管理工作提供依据。方法:数据取自天津市医保数据库,随机抽取50%,选择2型糖尿病患者的出院病例749741例,对患者的基本情况和住院费用进行分析。首先对职工和居民糖尿病患者的住院费用及其构成的变化趋势进行描述,再结合不同患者的并发症数量和类型,采用秩和检验分析住院费用的影响因素,根据结果运用多元线性回归和结构方程模型探讨影响因素以及之间的相互关系。所有分析过程使用SAS9.2和AMOS17.0软件完成。结果:2010-2014年间,在天津市糖尿病患者中,多数患者的并发症数量超过1种,并发症中冠心病最为常见。居民患者的并发症发生比例低于职工。患者住院费用中,来自药品比例最高,约占总费用的一半,其次比例较高的是检查费和治疗费。居民患者的费用普遍少于职工。5年中住院费用连续增长。并发症数量对住院费用的升高有明显提升作用。与微血管病变相比,大血管并发症更容易增加患者的医疗费用,而医院等级是增加住院费用最直接的因素,三级医院住院费最高,年龄越大的患者,男性患者以及职工的糖尿病患者费用更高。合并不同并发症类型的糖尿病患者,会选择不同的医院住院治疗,而居民和职工其住院费用和影响因素之间的关系也有差异。结论:天津市2型糖尿病患者更易选择三级医院住院治疗,且多有并发症。居民中患者在出现并发症的比例和医疗支出上普遍低于职工。此外住院费用成分不合理,主要来自药品,检查和费用三方面。并发症数目和类型,医院等级,年龄,性别与住院费用有关。居民和职工患者住院费用的影响因素不尽相同,提示决策者应根据不同的患者制定相应的医保政策,以提高卫生资源的利用率,降低糖尿病患者的疾病负担。
[Abstract]:Objective: to analyze the hospitalization data of type 2 diabetes mellitus patients in Tianjin medical insurance database from 2010 to 2014, to understand the basic information and hospitalization situation of patients with diabetes mellitus, and to analyze the number and type of complications. The composition of hospitalization expenses, and then study the trend of changes in costs, as well as influencing factors, to reduce the hospitalization costs of diabetes patients and the formulation of medical insurance policy to provide theoretical support. Methods: data were collected from Tianjin medical insurance database, 50 cases were randomly selected, and 749741 cases of type 2 diabetes were selected. The basic situation of the patients and hospitalization costs were analyzed. Firstly, the hospital expenses of the staff and residents of diabetes patients and the trend of their composition were described, and then combined with the number and types of complications of different patients. The influencing factors of hospitalization expenses were analyzed by rank sum test. According to the results, the multivariate linear regression and structural equation model were used to study the influencing factors and the relationship between them. All the analysis processes were completed by SAS9.2 and AMOS17.0 software. 2010-2014. In Tianjin diabetes patients, the majority of patients have more than one kind of complications, coronary heart disease is the most common complication. The incidence of complications in residents is lower than that of workers. The highest proportion comes from drugs, accounting for about half of the total cost. The next higher proportion is the examination fee and the treatment fee. The resident patient's expense is generally less than the worker. In 5 years the hospitalization expense increases continuously. The complication quantity has the obvious enhancement function to the hospitalization expense. Than. Macrovascular complications are more likely to increase the patient's medical costs, and hospital level is the most direct factor to increase the cost of hospitalization, tertiary hospital hospitalization fee is the highest, the older the patients. Male patients, as well as workers with diabetes, are more expensive. Patients with diabetes with different types of complications will choose different hospital hospitalizations. There are also differences between residents and workers in the relationship between hospitalization costs and influencing factors. Conclusion: type 2 diabetes patients in Tianjin are more likely to choose hospitalization treatment in tertiary hospitals. And there are more complications. Patients in the proportion of complications and medical expenses are generally lower than the staff. In addition, the composition of hospital expenses is unreasonable, mainly from drugs. The number and type of complications, hospital grade, age and gender were related to the cost of hospitalization. The influencing factors of hospitalization expenses of residents and workers were different. It is suggested that the decision makers should make corresponding medical insurance policies according to different patients in order to increase the utilization rate of health resources and reduce the disease burden of patients with diabetes mellitus.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.3;R587.1

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