本文選題：住院費用 + 市醫(yī)保�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:通過了解長春市市醫(yī)�；颊呒捌渥≡嘿M用的基本情況、結(jié)構(gòu)變動情況以及影響因素,分析影響住院費用的可能因素,探索切實有效的干預(yù)手段,為醫(yī)院管理人員開展費用管理以及建立合理、高效的費用管控辦法,遏制住院費用不合理增長提供切實可行的決策依據(jù),實現(xiàn)醫(yī)院、醫(yī)療保險管理機構(gòu)和患者的三方共贏局面。方法:本研究采用文獻研究法,查閱國內(nèi)外關(guān)于醫(yī)療費用相關(guān)的文獻與政策文件進行理論研究;運用描述性分析方法了解2013-2015年長春市某三甲醫(yī)院市醫(yī)�；颊叩男詣e、年齡、住院天數(shù)、支付方式、費用性質(zhì)等的分布情況及其住院費用的基本情況;應(yīng)用結(jié)構(gòu)變動度分析住院費用結(jié)構(gòu)變動情況;采用灰色關(guān)聯(lián)度分析各類費用(如綜合醫(yī)療服務(wù)類費用、藥品類費用、診斷類費用等)與住院費用的關(guān)聯(lián)程度;運用秩和檢驗進行單因素分析;以ln住院費用作為因變量,以年齡、性別、費用性質(zhì)、人員類別和支付方式等作為自變量,采用多元線性回歸分析對住院費用進行多因素分析,應(yīng)用統(tǒng)計軟件SPSS20.0對市醫(yī)�；颊咦≡嘿M用的相關(guān)數(shù)據(jù)進行處理。結(jié)果:2013-2015年市醫(yī)保住院患者人數(shù)增加,女性患者人數(shù)高于男性,且住院費用呈逐年上升趨勢;45-60歲與60-75歲兩組患者人數(shù)較多,60歲以上患者人數(shù)及占比逐年增加;在心內(nèi)科與腫瘤中心住院的患者數(shù)量較多,與患者所患疾病中以心腦血管疾病和惡性腫瘤最多相對應(yīng);總額預(yù)付的患者人數(shù)多于其他支付方式。結(jié)構(gòu)變動度分析顯示,藥品類人均住院費用最高,其次是綜合醫(yī)療服務(wù)類,血液和血液制品類的人均住院費用最低;2013-2015年住院費用的結(jié)構(gòu)變動度最大,為4.25%,2013-2014年住院費用的結(jié)構(gòu)變動度最小,為2.08%,2014-2015年住院費用的結(jié)構(gòu)變動度為3.32%;綜合醫(yī)療服務(wù)類費用的結(jié)構(gòu)變動方向在三年間都為正向變動,治療類、藥品類與血液和血液制品類在三年間均為負向變動;2013-2014年對住院費用結(jié)構(gòu)變動貢獻率最大的是治療類費用,其貢獻率為37.02%,2014-2015年與2013-2015年對住院費用結(jié)構(gòu)變動貢獻率最大的都是綜合醫(yī)療服務(wù)類,分別為50.00%與50.12%�；疑P(guān)聯(lián)度分析顯示,各類費用與次均費用的關(guān)聯(lián)度以藥品類最高,其次是綜合醫(yī)療服務(wù)類、治療類、診斷類,血液和血液制品類的關(guān)聯(lián)度最低。單因素分析顯示,不同性別的市醫(yī)保患者的住院費用差異具有顯著性(p0.001);不同年齡的市醫(yī)�；颊唛g住院費用的差異具有統(tǒng)計學(xué)意義(p0.001);不同費用性質(zhì)的市醫(yī)�；颊唛g住院費用的差異具有統(tǒng)計學(xué)意義(p0.001);支付方式不同,市醫(yī)保患者間住院費用的差異具有統(tǒng)計學(xué)意義(p0.001);住院期間感染與否,引起住院費用的差異具有統(tǒng)計學(xué)意義(p0.001);不同住院天數(shù)的市醫(yī)�；颊唛g住院費用的差異具有統(tǒng)計學(xué)意義(p0.001);不同人員類別的市醫(yī)�；颊唛g住院費用的差異具有統(tǒng)計學(xué)意義(p0.001)。多元線性回歸分析顯示,支付方式、是否感染、入院情況以及年齡是患者住院費用的主要影響因素,人員類別與費用性質(zhì)對住院費用的影響較小。結(jié)論:1.2013-2015年長春市某三甲醫(yī)院市醫(yī)保患者人數(shù)以及住院費用呈逐年上升趨勢。2.住院費用逐年上升,其不合理性主要體現(xiàn)在藥品類費用增長速度有所下降,但是在住院費用中占比最高,與住院費用的關(guān)聯(lián)度也最高。同時綜合醫(yī)療服務(wù)類費用與住院費用的關(guān)聯(lián)度僅次于藥品類費用,二者均需醫(yī)務(wù)工作者以及醫(yī)院管理者的關(guān)注。3.按照不同分類變量如費用性質(zhì)、支付方式、入院情況、住院天數(shù)、是否感染、等分析市醫(yī)保患者住院費用,發(fā)現(xiàn)各分類變量所引起的住院費用的差異均具有統(tǒng)計學(xué)意義,并且支付方式、是否感染等是對住院費用影響較大的因素。4.國家和政府應(yīng)進一步深化醫(yī)藥衛(wèi)生體制改革,明確醫(yī)療機構(gòu)功能定位,推進支付制度改革,完善分級診療以及藥品零差率政策,提高醫(yī)療保障水平,減輕患者醫(yī)療負擔(dān)。在政策的指導(dǎo)下,醫(yī)院應(yīng)該變被動為主動,自覺加強內(nèi)部微觀管理,完善和優(yōu)化醫(yī)院管理規(guī)章和制度,提高醫(yī)療服務(wù)水平和診療質(zhì)量,將合理控制醫(yī)療費用深入到臨床科室,與臨床績效掛鉤,激發(fā)其主動性和積極性。
[Abstract]:Objective: through understanding the basic situation of the medical insurance patients and their hospitalization expenses in Changchun City, the structural changes and the influencing factors, the possible factors affecting the hospitalization cost are analyzed, the effective and effective intervention means are explored, the cost management is carried out for the hospital administrators, and the reasonable and efficient cost management and control measures are set up to contain the incompatibility of hospitalization expenses. It provides a practical decision basis to achieve a win-win situation for three parties in hospitals, medical insurance management institutions and patients. Methods: This study uses literature research method to consult the literature and policy documents related to medical costs at home and abroad and to understand the 2013-2015 years of a three a medicine in Changchun by descriptive analysis. The distribution of the sex, age, the days of hospitalization, the way of payment, the nature of the expenses, the basic situation of the cost of hospitalization, the changes in the structural changes of the hospitalization expenses were analyzed with the structural change degree, and the various expenses (such as comprehensive medical service charge, drug cost, diagnostic cost, etc.) were analyzed with the grey correlation degree. A single factor analysis was carried out by the rank sum test; the LN hospitalization cost was used as the dependent variable, the age, sex, the cost nature, the personnel category and the way of payment were used as independent variables. The multivariate linear regression analysis was used to analyze the hospitalization expenses, and the cost of hospitalization for the medical insurance patients was applied by the statistical software SPSS20.0. Results: the number of hospitalized patients in the city increased in 2013-2015 years, the number of female patients was higher than that of men, and the cost of hospitalization was increasing year by year; the number of patients aged 45-60 years and 60-75 years old and two groups were more, the number and proportion of patients above 60 years of age increased year by year; the number of patients hospitalized in the Department of Cardiology and cancer center was more, and the patients were more than those in the hospital. The number of patients with cardiovascular and cerebrovascular diseases and malignant tumors was most appropriate; the total number of prepaid patients was more than the other modes of payment. The structural change degree analysis showed that the per capita hospitalization cost was the highest, followed by the comprehensive medical services, the lowest per capita hospitalization expenses of blood and blood products, and the structure of the 2013-2015 years of hospitalization expenses. The maximum change degree was 4.25%, and the structural change degree of hospitalization expenses was the lowest, 2.08%, and the structural change degree of the hospitalization expenses in 2014-2015 years was 3.32%. The structural change direction of the comprehensive medical service cost was positive change in the three years, the treatment class, the medicine and blood and blood products were all negative changes in three years; 2013-2014 The largest contribution rate to the structural change of hospitalization costs in the year was the treatment cost. The contribution rate was 37.02%. The largest contribution rate of the 2014-2015 and 2013-2015 years to the changes in the structure of hospitalization expenses was the comprehensive medical service class. 50% and 50.12%. grey correlation analysis respectively showed that the association between the various types of cost and the sub average cost was the highest in the drug category. The second was the comprehensive medical service class, the treatment class, the diagnosis class, the blood products and the blood products. The single factor analysis showed that the difference of hospitalization expenses of the medical insurance patients with different sex was significant (p0.001); the difference of hospitalization expenses among the medical insurance patients of different ages was statistically significant (p0.001); the different cost properties were different. The difference of hospitalization expenses among the medical insurance patients in the city was statistically significant (p0.001); the difference in the mode of payment was statistically significant (p0.001); the difference of the hospitalization expenses during the hospitalization was statistically significant (p0.001); the difference of hospitalization expenses among the medical insurance patients with different days of hospitalization was different There were statistical significance (p0.001); the difference of hospitalization costs among medical insurance patients in different categories was statistically significant (p0.001). Multiple linear regression analysis showed that payment, infection, admission, and age were the main factors affecting hospitalization expenses, and the impact of personnel category and cost nature on hospitalization costs was more than that of the patients. Conclusion: in 1.2013-2015, the number of medical insurance patients in a three a hospital in Changchun and the cost of hospitalization increased year by year, and the cost of hospitalization increased year by year. The irrational sex was mainly reflected in the decline in the rate of drug cost growth, but the ratio of hospitalization expenses was the highest, and the degree of association with hospitalization costs was the highest. At the same time, comprehensive medical treatment was also found. The relationship between the service cost and the hospitalization cost is second to the drug cost. The two parties need the attention of the medical workers and the hospital administrators to.3. according to the different classification variables such as the cost nature, the way of payment, the admission, the days of hospitalization, whether the infection, and so on, and find the hospitalization expenses caused by the various classified variables. The differences are statistically significant, and the way of payment and infection are the factors affecting the cost of hospitalization..4. countries and governments should further deepen the reform of the medical and health system, define the functional orientation of the medical institutions, promote the reform of the payment system, improve the classification and treatment as well as the policy of drug zero difference, and improve the level of medical security. Under the guidance of policy, the hospital should be passive to be passive, consciously strengthen the internal micro management, improve and optimize the hospital management rules and regulations, improve the medical service level and quality of diagnosis and treatment, the reasonable control of medical expenses to clinical departments, and clinical performance linked to stimulate their initiative and enthusiasm.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.3

【參考文獻】

相關(guān)期刊論文 前10條

1 鄧蓬華;杜蕾蕾;厲旦;沈遲;高建民;;陜西省某三甲醫(yī)院高額住院費用分析[J];衛(wèi)生經(jīng)濟研究;2016年10期

2 陳暢;張曉;張文杰;徐春雨;段明妍;;江蘇省某市6種重大疾病患者住院醫(yī)療費用[J];中國老年學(xué)雜志;2016年16期

3 邱雅;孫青川;;醫(yī)療費用影響因素的實證分析[J];中國統(tǒng)計;2016年08期

4 何思長;趙大仁;孫渤星;劉志會;張瑞華;;2009—2014年四川省公立醫(yī)院醫(yī)療費用結(jié)構(gòu)變動情況分析[J];中國衛(wèi)生經(jīng)濟;2016年07期

5 劉暢;楊云濱;;基層醫(yī)院的病例分型及其醫(yī)療費用分析[J];中國臨床藥理學(xué)雜志;2016年12期

6 周少甫;范兆媛;;年齡對醫(yī)療費用增長的影響:基于分位數(shù)回歸模型的分析[J];中國衛(wèi)生經(jīng)濟;2016年06期

7 張敏;趙琨;李雪;鮑國春;;青島市某醫(yī)院臨床路徑改革對醫(yī)療費用影響的ITS分析[J];中國衛(wèi)生經(jīng)濟;2016年02期

8 潘悅?cè)A;崔夢迪;李雪輝;;藥品零加成對醫(yī)療費用的影響及補償機制探索[J];上海交通大學(xué)學(xué)報(醫(yī)學(xué)版);2015年11期

9 劉軍強;劉凱;曾益;;醫(yī)療費用持續(xù)增長機制——基于歷史數(shù)據(jù)和田野資料的分析[J];中國社會科學(xué);2015年08期

10 夏軍芳;曹秀玲;徐凌忠;許建強;;山東省某醫(yī)院剖宮產(chǎn)住院費用變化及影響因素分析[J];中國衛(wèi)生經(jīng)濟;2015年07期

相關(guān)重要報紙文章 前2條

1 陳娟;;徐州醫(yī)保智能監(jiān)控引全國關(guān)注[N];徐州日報;2015年

2 松范;;英國醫(yī)療費用全歐洲最高[N];醫(yī)藥經(jīng)濟報;2004年

相關(guān)碩士學(xué)位論文 前7條

1 陳微;基于總額預(yù)算的三甲醫(yī)院醫(yī)保指標核算管理體系研究[D];吉林大學(xué);2015年

2 劉美娟;腦梗死患者住院費用影響因素分析及預(yù)付費用模型構(gòu)建[D];山西醫(yī)科大學(xué);2015年

3 付曉萌;天津市參保急性心肌梗死患者住院費用及DRGs初探研究[D];天津醫(yī)科大學(xué);2015年

4 楊玉婷;醫(yī)�？傤~預(yù)付制對醫(yī)院服務(wù)質(zhì)量、效率與費用的影響研究[D];第二軍醫(yī)大學(xué);2014年

5 賈瓊;基于結(jié)構(gòu)方程模型的天津市醫(yī)保肝硬化患者住院費用分析[D];天津醫(yī)科大學(xué);2013年

6 陳金彪;天津市參保乙肝患者住院費用及個人負擔(dān)研究[D];天津醫(yī)科大學(xué);2013年

7 馬躍申;基于R軟件的腦出血患者住院費用分析[D];天津醫(yī)科大學(xué);2013年

，

本文編號：1965002