糖尿病患者门诊就医流向与费用分析——基于某省新农合数据

发布时间：2018-08-04 14:01

【摘要】：目的:探究糖尿病患者门诊就医流向与费用特点,为分级诊疗等相关卫生政策的实施与推广提供理论根据。方法:选取东部某省13个区县,采用描述性统计,分析糖尿病患者在一、二、三级医疗机构的就诊分布和诊疗费用情况。结果:2009—2013年无并发症糖尿病患者在三级医疗机构的诊疗人次由1 895降低到661,其占比由3.05%降低到0.57%,有并发症患者在三级医疗机构的诊疗人次由179增加到524,且在2011—2013年间,其占比由3.27%增加到4.24%。两类患者门诊次均费用和次均个人负担差别较大,且级别越高,差别越大;在一、二、三级医疗机构中,有并发症患者的次均费用分别是无并发症患者的2.50倍、3.34倍、3.75倍,前者的次均个人负担费用分别是后者的2.62倍、3.66倍、3.96倍。结论:该省基层门诊服务利用取得一定成效,但也存在着患者就医选择的不合理,有并发症糖尿病的患者越来越多的流向三级医疗机构;相比于无并发症患者,有并发症患者面临更大的经济负担。未来应进一步加强基础医疗机构建设,提升其预防、诊疗和控制糖尿病及并发症的服务质量与能力,合理引导糖尿病患者到基层医疗卫生机构就医。
[Abstract]:Objective: to explore the characteristics of outpatient care flow and cost of diabetes mellitus patients, and to provide theoretical basis for the implementation and promotion of related health policies such as grading diagnosis and treatment. Methods: selecting 13 districts and counties in a certain province in the east, using descriptive statistics, we analyzed the distribution of patients with diabetes mellitus in the first, second and third level medical institutions and the cost of diagnosis and treatment. Results from 2009 to 2013, the number of patients with diabetes mellitus without complications in tertiary medical institutions decreased from 1,895 to 661.The proportion of patients with diabetes decreased from 3.05% to 0.57. The number of visits of patients with complications increased from 179 to 524 in tertiary medical institutions, and between 2011 and 2013, the number of patients with complications increased from 179 to 524. Its proportion increased from 3.27% to 4.24%. The difference of the average outpatient cost and the average personal burden between the two types of patients was greater, and the higher the level, the greater the difference; in the first, second, and third level medical institutions, the average cost of the patients with complications was 2.50 times, 3.34 times to 3.75 times as much as that of the patients without complications, respectively. The average personal cost of the former is 2.62 times, 3.66 times and 3.96 times of that of the latter, respectively. Conclusion: the utilization of primary outpatient service in this province has achieved some results, but there is also an unreasonable choice of patients seeking medical treatment. More and more patients with diabetes with complications are going to tertiary medical institutions, compared with patients without complications. Patients with complications face a greater financial burden. In the future, we should further strengthen the construction of basic medical institutions, improve their quality of service and ability to prevent, diagnose and control diabetes mellitus and complications, and reasonably guide patients with diabetes to seek medical treatment in primary medical and health institutions.
【作者单位】：北京大学医学部公共卫生学院;国家卫生计生委医院管理研究所;
【基金】：糖尿病分级诊疗政策研究项目
【分类号】：R197.1;R587.1

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