天津市三级医疗机构脑卒中患者住院费用研究

发布时间：2018-04-24 10:32

本文选题：脑卒中 + 医疗保险　；参考：《天津医科大学》2014年硕士论文

【摘要】：目的探讨天津市参加城镇职工、城乡居民基本医疗保险的脑卒中患者住院费用构成、个人负担率及医保政策对其影响。为保障医疗保险基金的合理使用,控制医疗费用、降低患者的自费率,减轻患者经济负担提供参考依据。方法从天津市参加城镇职工、城乡居民基本医疗保险的住院患者数据库中整群抽取2010年1月1日～2012年12月31日三级医疗机构脑卒中患者146826例,观察不同性别、年龄、卒中亚型、住院日及预后对住院费用的影响,分析住院费用的主要结构；同时选取两所医疗机构脑卒中患者26613例,观察不同险种、卒中亚型对个人负担率的影响,分析自费部分的主要结构。研究使用Excel2003建立数据库,用SPSS17.0软件进行统计学分析。结果缺血性脑卒中患者127090例,多于出血性脑卒中。男性患者87666例,占59.71%,高于女性(χ2=72.31,P0.001)。缺血性脑卒中患者的平均年龄为65.83±11.38岁,高于出血性脑卒中患者(t=17.47,P0.001)。缺血性脑卒中疾病总费用180061.14万元,占脑卒中社会经济负担的77.72%。出血性脑卒中次均费用2.61±3.34万元,高于缺血性脑卒中。老年组缺血性脑卒中69074例,占47.04%；发生费用100814.37万元,占55.99%,所占比例最多。住院日中位数14天,住院费用中位数1.21万元,患者住院日与发生费用呈正相关。住院费用中药品费114837.22万元,占49.56%,比例最高。死亡组的次均费用为3.39±2.04万元,高于治愈好转组(t=53.64,P0.001)。两所医疗机构脑卒中住院患者的人次均费用1.87±2.14万元,高于天津市三级医疗机构的平均水平。城职患者平均年龄64.07±11.44岁(t=6.84,P0.001)、平均住院日113.65±9.15天(t=18.18,P0.001)、次均费用1.89±2.26万元(t=2.77,P=0.006)均高于城乡患者。两所医疗机构的平均个人负担率49.20%,高于天津市三级医疗机构。城乡居民个人负担率为68.37%,大于城职患者。城职患者自费金额占实际自负的62.29%,大于城乡患者；城乡患者政策性自负金额占实际自负的56.38%,大于城职患者。城职、城乡患者自费总额中药品费占比分别为27.31%、28.90%,对自费构成影响因素最大。自费结构在费用组成中的影响因素依次为药品费、医用材料费、治疗费和检查费。结论通过对天津市三级医疗机构脑卒中住院患者的费用研究,我们得出如下结论：男性缺血性脑卒中患者占脑卒中总费用最高；出血性脑卒中患者平均经济负担高于缺血性脑卒中患者；老年组缺血性脑卒中患者住院例数及发生费用占脑卒中比重最大,应重点关注。两所医疗机构脑卒中住院患者的个人负担率明显高于天津市三级医疗机构。城乡患者个人负担率偏高,结构不合理。应重点调控自费药品及医用材料费。
[Abstract]:Purpose To explore the inpatient cost composition, personal burden rate and medical insurance policy of stroke patients participating in urban and rural residents' basic medical insurance in Tianjin. In order to ensure the rational use of medical insurance fund, control medical expenses, reduce the self-rate of patients, reduce the economic burden of patients to provide a reference basis. Method 146826 stroke patients in tertiary medical institutions from January 1, 2010 to December 31, 2012 were collected from the inpatient database of basic medical insurance for urban and rural residents in Tianjin. The influence of hospitalization days and prognosis on hospital expenses and the main structure of hospitalization expenses were analyzed, and 26613 stroke patients in two medical institutions were selected to observe the influence of different types of insurance and the type of stroke on the individual burden rate. Analyze the main structure of self-financing part. Excel2003 was used to establish database and SPSS17.0 software was used for statistical analysis. Result 127090 patients with ischemic stroke were more than those with hemorrhagic stroke. 87666 cases (59.71%) of male patients were higher than that of females (蠂 2 / 72.31%, P 0.001). The average age of patients with ischemic stroke was 65.83 卤11.38 years old, which was higher than that of patients with hemorrhagic stroke. The total cost of ischemic stroke was 1.8006114 billion yuan, which accounted for 77.72% of the social and economic burden of stroke. The average cost of hemorrhagic stroke was 2.61 卤33400 yuan, which was higher than that of ischemic stroke. In the elderly group, 69074 cases (47.04) had ischemic stroke, and the cost was 1.0081437 billion yuan (55.99%). The median day of hospitalization was 14 days and the median cost of hospitalization was 12100 yuan. The cost of drugs was 1.1483722 billion yuan, accounting for 49.56 yuan, and the proportion was the highest. The average cost of the death group was 3.39 卤20400 yuan, which was higher than that of the cured group. The average cost of inpatients with stroke in two medical institutions was 1.87 卤21400 yuan, which was higher than the average level of third-level medical institutions in Tianjin. The average age of urban patients was 64.07 卤11.44 years old, the average hospitalization days were 113.65 卤9.15 days, the average cost was 1.89 卤22600 yuan, and the average cost was 1.89 卤22600 yuan. The average personal burden rate of the two medical institutions was 49.20, higher than that of Tianjin tertiary medical institutions. The personal burden rate of urban and rural residents was 68.37, larger than that of urban patients. The amount of self-expense of urban vocational patients accounted for 62.29% of actual conceit, which was larger than that of urban and rural patients, and the policy amount of urban and rural patients accounted for 56.38% of actual conceit, which was larger than that of urban vocational patients. In urban and rural areas, the proportion of drug expenses was 27.31%, 28.90%, which was the most important factor. The influencing factors of the self-funded structure in the composition of the cost are medicine fee, medical material cost, treatment fee and examination fee. Conclusion By studying the cost of inpatients with stroke in tertiary medical institutions in Tianjin, we draw the following conclusions: male ischemic stroke patients account for the highest total cost of stroke; The average economic burden of patients with hemorrhagic stroke was higher than that of patients with ischemic stroke. The individual burden rate of stroke inpatients in the two medical institutions was significantly higher than that in Tianjin tertiary medical institutions. The individual burden rate of urban and rural patients is on the high side and the structure is unreasonable. We should focus on the regulation and control of self-funded drugs and medical materials.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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