辽宁省八家县医院新农合脑梗死住院患者费用支付研究
发布时间：2018-07-16 11:55
【摘要】：目的:通过对辽宁省八家县医院脑梗死住院患者医疗费用进行分析,了解住院费用分布情况,寻找住院费用影响因素,运用统计学模型对费用进行分层管理,比较不同地区同种疾病不同费用分层患者的疾病特点和费用差异,为辽宁省新农合费用支付改革提供参考依据。方法:选自新农合上报的2014年1月1日—12月31日期间脑梗死住院患者病案数据4156例作为研究对象。应用SPSS统计软件,对辽宁省八家县级医院脑梗死住院病人的住院费用进行分析,采用百分位数法对脑梗死费用进行分层和探讨;采用相关分析、筛查出影响住院费用的主要变量,并用多元线性回归方法对住院费用影响因素进行分析。利用决策树模型(CHAID),对不同费用组患者进行分类,寻找医疗费用与患者疾病程度之间的关系。结果:1.脑梗死住院患者共计4156人,其中女性患者2137人,占51.4%,男性2019人,占48.6%;平均年龄66.3±10.6岁(27岁-98岁);年龄分段60-69岁人数最多;56.6%门诊入院;70.6%患者合并有并发症。2.不同医院之间,8家医疗机构中A医院患者最多,占29.9%(1242人),E医院最少,为1.3%(55人);性别方面,除了E医院男性占72.7%(40人),女性占27.3%(15人),其他7家医院男性比为45.8%-59.4%之间。女性比为40.6%-54.2%之间。年龄段分布,60岁以下各医院占比H医院最少,E医院最高,80岁以上占比H医院最多。3.脑梗死平均费用6599.5±3850.5元(M=5961.5,IQR=3406.7);日均费用655.0±338.6元(M=584.5,IQR=242),平均住院天数10.73天(M=11,IQR=7)。不同性别之间,女性平均住院日(10.9天)高于男性(10.5天)。随着年龄段的增高,日均医疗费用逐渐增多,总体来看,八家医院之间平均住院日、平均住院费用和日均费用差异较大。4.八家县医院脑梗死费用差异较大,平均费用F医院最高9070.7元,A医院平均费用最低5424.0元,其他六家医疗机构在5759.4~7578.7元之间;从费用分布来看,H医院、B医院、D医院、C医院高中低三组费用分布比较均衡,但是高费用分组各医院费用相差较大,F、E、G三家医院高费用组平均费用均超过2万元,其他5家医院高费用组均值在1万~1.5万之间,费用差异达1倍以上。5.肺内感染和糖尿病是病例分类的重要节点。6.脑梗死的住院影响因素有实际住院天数、入院途径,有无糖尿病,有无肺内感染,有无高血压,年龄分段,其中离院方式、入院途径呈负相关。结论:1.辽宁省8家县级医疗机构间脑梗死医疗费用差异较大,影响医保支付的公平性。2.肺内感染,糖尿病是医疗费用分层的重要节点,但有8.2%的病例没有任何并发症却出现在高费用组,应加强医疗服务行为监管,确保新农合基金的合理使用。3.住院天数、入院途径,糖尿病、肺内感染、高血压以及年龄是医疗费用的主要影响因素。4.不同医院通过对费用进行分层管理,根据不同费用分层患者的疾病特点和费用差异进行支付和监管,可以减少一些不必要、不合理的诊疗行为,减少住院天数,促进医保基金合理有效使用;同时维护了病情重、费用高的患者医疗服务质量,促进医疗服务人员的积极性。
[Abstract]:Objective: to analyze the medical expenses of inpatients in eight hospitals in Liaoning Province, to understand the distribution of hospitalization expenses, to find the influencing factors of hospitalization expenses, to use statistical model to manage the cost by stratified management, to compare the disease characteristics and cost differences of the patients with different cost stratification in different areas, for the new Liaoning province. Methods: 4156 cases of hospitalized patients with cerebral infarction were selected from January 1, 2014 to December 31st of NCMS as the research object. The hospitalization expenses of cerebral infarction inpatients in eight county hospitals in Liaoning province were analyzed with SPSS statistical software, and the percentile method was used for the cerebral infarction. The death cost was stratified and discussed; the main variables affecting the hospitalization cost were screened by correlation analysis, and the factors affecting the hospitalization cost were analyzed by multiple linear regression. The decision tree model (CHAID) was used to classify the patients in different cost groups to find the relationship between medical expenses and the degree of patients' disease. Results: 1. brain stem. The total number of dead inpatients was 4156, of which 2137 were female, 51.4% were women, 2019 were male and 48.6%, and the average age was 66.3 + 10.6 years (27 years old -98); the number of age 60-69 years was the most; 56.6% outpatients were hospitalized; 70.6% patients were combined with complications in different hospitals, and A hospitals were the largest in 8 medical institutions, accounting for 29.9% (1242 people), and E hospital at least, For 1.3% (55 people), in addition to E hospital male 72.7% (40 people), women accounted for 27.3% (15), the other 7 hospitals were between 45.8%-59.4% and 40.6%-54.2%. Age distribution, the hospitals under 60 years of age were the least in H hospital, E hospital was the highest, and the average cost of the most.3. cerebral infarction was 6599.5 + 3850.5 than that of H hospital. M=5961.5 (IQR=3406.7); the average daily cost of 655 + 338.6 yuan (M=584.5, IQR=242), average hospitalization days 10.73 days (M=11, IQR=7). The average hospitalization day (10.9 days) for women was higher than that of men (10.5 days). With the increase of age, the daily average medical expenses increased gradually. In general, the average hospitalization day between eight hospitals, the average hospitalization fee. The difference of the cost difference between the average cost and the daily average was larger in.4. eight county hospitals, the average cost of F hospital was the highest, the average cost of A hospital was 5424 yuan, and the other six medical institutions were between the 5759.4~7578.7 yuan. From the cost distribution, the cost distribution of the three groups in H hospital, B hospital, D hospital and C hospital high school and low three groups was more balanced but high, but high, but high The cost of each hospital was quite different. The average cost of the high cost group in the three hospitals of F, E and G was more than 20 thousand yuan. The average cost of the other 5 hospitals was 10 thousand ~1.5 million, the difference of the cost was more than 1 times more than 1 times of the.5. lung infection and diabetes was the important node of the case classification of.6. brain infarction. There were no diabetes, no diabetes, no pulmonary infection, hypertension, age segmentation, the way of hospitalization and admission were negatively correlated. Conclusion: 1. the medical expenses of cerebral infarction between 8 County medical institutions in Liaoning province are different, which affect the fair.2. lung infection, and diabetes is an important node of medical expense stratification, but there are 8.2% diseases. There is no complication in the high cost group. The supervision of medical service behavior should be strengthened to ensure the rational use of the medical service, to ensure the rational use of the new rural cooperative fund (NCF), the number of days of.3. hospitalization, access to hospital, diabetes, pulmonary infection, hypertension, and age are the main factors affecting the cost of medical treatment,.4. different hospitals by stratified management of the cost, according to the different cost points. The payment and supervision of the disease characteristics and cost differences of the patients can reduce some unnecessary and unreasonable diagnosis and treatment behavior, reduce the number of days in hospital, promote the rational and effective use of the medical insurance fund, and maintain the medical service quality of the patients with heavy condition and high cost, and promote the enthusiasm of medical service personnel.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.323;R743.33
本文编号：2126310
[Abstract]:Objective: to analyze the medical expenses of inpatients in eight hospitals in Liaoning Province, to understand the distribution of hospitalization expenses, to find the influencing factors of hospitalization expenses, to use statistical model to manage the cost by stratified management, to compare the disease characteristics and cost differences of the patients with different cost stratification in different areas, for the new Liaoning province. Methods: 4156 cases of hospitalized patients with cerebral infarction were selected from January 1, 2014 to December 31st of NCMS as the research object. The hospitalization expenses of cerebral infarction inpatients in eight county hospitals in Liaoning province were analyzed with SPSS statistical software, and the percentile method was used for the cerebral infarction. The death cost was stratified and discussed; the main variables affecting the hospitalization cost were screened by correlation analysis, and the factors affecting the hospitalization cost were analyzed by multiple linear regression. The decision tree model (CHAID) was used to classify the patients in different cost groups to find the relationship between medical expenses and the degree of patients' disease. Results: 1. brain stem. The total number of dead inpatients was 4156, of which 2137 were female, 51.4% were women, 2019 were male and 48.6%, and the average age was 66.3 + 10.6 years (27 years old -98); the number of age 60-69 years was the most; 56.6% outpatients were hospitalized; 70.6% patients were combined with complications in different hospitals, and A hospitals were the largest in 8 medical institutions, accounting for 29.9% (1242 people), and E hospital at least, For 1.3% (55 people), in addition to E hospital male 72.7% (40 people), women accounted for 27.3% (15), the other 7 hospitals were between 45.8%-59.4% and 40.6%-54.2%. Age distribution, the hospitals under 60 years of age were the least in H hospital, E hospital was the highest, and the average cost of the most.3. cerebral infarction was 6599.5 + 3850.5 than that of H hospital. M=5961.5 (IQR=3406.7); the average daily cost of 655 + 338.6 yuan (M=584.5, IQR=242), average hospitalization days 10.73 days (M=11, IQR=7). The average hospitalization day (10.9 days) for women was higher than that of men (10.5 days). With the increase of age, the daily average medical expenses increased gradually. In general, the average hospitalization day between eight hospitals, the average hospitalization fee. The difference of the cost difference between the average cost and the daily average was larger in.4. eight county hospitals, the average cost of F hospital was the highest, the average cost of A hospital was 5424 yuan, and the other six medical institutions were between the 5759.4~7578.7 yuan. From the cost distribution, the cost distribution of the three groups in H hospital, B hospital, D hospital and C hospital high school and low three groups was more balanced but high, but high, but high The cost of each hospital was quite different. The average cost of the high cost group in the three hospitals of F, E and G was more than 20 thousand yuan. The average cost of the other 5 hospitals was 10 thousand ~1.5 million, the difference of the cost was more than 1 times more than 1 times of the.5. lung infection and diabetes was the important node of the case classification of.6. brain infarction. There were no diabetes, no diabetes, no pulmonary infection, hypertension, age segmentation, the way of hospitalization and admission were negatively correlated. Conclusion: 1. the medical expenses of cerebral infarction between 8 County medical institutions in Liaoning province are different, which affect the fair.2. lung infection, and diabetes is an important node of medical expense stratification, but there are 8.2% diseases. There is no complication in the high cost group. The supervision of medical service behavior should be strengthened to ensure the rational use of the medical service, to ensure the rational use of the new rural cooperative fund (NCF), the number of days of.3. hospitalization, access to hospital, diabetes, pulmonary infection, hypertension, and age are the main factors affecting the cost of medical treatment,.4. different hospitals by stratified management of the cost, according to the different cost points. The payment and supervision of the disease characteristics and cost differences of the patients can reduce some unnecessary and unreasonable diagnosis and treatment behavior, reduce the number of days in hospital, promote the rational and effective use of the medical insurance fund, and maintain the medical service quality of the patients with heavy condition and high cost, and promote the enthusiasm of medical service personnel.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.323;R743.33
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