【摘要】：目的:分析生育保險(xiǎn)參保人員住院分娩的醫(yī)療費(fèi)用,了解影響住院分娩醫(yī)療費(fèi)用的因素,研究各因素對(duì)住院醫(yī)療費(fèi)用的作用強(qiáng)度,為生育保險(xiǎn)的有效管理提供參考依據(jù)。方法:研究2013-2016年在山西省太原市某三級(jí)醫(yī)院所有住院分娩的省直生育保險(xiǎn)參保人員。從該醫(yī)院HIS系統(tǒng)收集產(chǎn)婦的出院診斷、生育方式、有無(wú)并發(fā)癥、胎數(shù)、費(fèi)用等信息,并查閱醫(yī)保辦公室的相關(guān)報(bào)銷(xiāo)資料作為補(bǔ)充。對(duì)產(chǎn)婦的年齡、職業(yè)、分娩方式、孕周、孕產(chǎn)次、病理妊娠、是否多胎妊娠、住院天數(shù)、產(chǎn)后并發(fā)癥、住院費(fèi)用明細(xì)(包含床位費(fèi)、護(hù)理費(fèi)、治療費(fèi)、檢查費(fèi)、手術(shù)麻醉費(fèi)、藥品費(fèi)、材料費(fèi)、其它費(fèi))進(jìn)行統(tǒng)計(jì)描述,并應(yīng)用單因素和多因素分析的方法分析上述各因素與住院醫(yī)療費(fèi)用之間的關(guān)系。結(jié)果:1、該三級(jí)醫(yī)院住院分娩醫(yī)療費(fèi)用構(gòu)成該三級(jí)醫(yī)院住院分娩醫(yī)療費(fèi)用由高到低依次為:藥品費(fèi)、手術(shù)麻醉費(fèi)、材料費(fèi)、治療費(fèi)、檢查費(fèi)、床位費(fèi)、其它費(fèi)、護(hù)理費(fèi),其中排名前三位的藥品費(fèi)、手術(shù)費(fèi)和材料費(fèi),合計(jì)占總費(fèi)用的76.78%。2、影響該三級(jí)醫(yī)院住院分娩醫(yī)療費(fèi)用的主要因素單因素分析顯示高齡組的平均住院分娩醫(yī)療費(fèi)用高于其它年齡組,剖宮產(chǎn)組高于難產(chǎn)分娩組、人工干預(yù)分娩組和自然分娩組,初產(chǎn)婦組低于經(jīng)產(chǎn)婦組,病理妊娠組高于正常妊娠組,多胎妊娠組高于單胎妊娠組,有產(chǎn)后并發(fā)癥產(chǎn)婦組高于無(wú)并發(fā)癥產(chǎn)婦組,住院天數(shù)越多費(fèi)用越高。不同職業(yè)、不同孕齡產(chǎn)婦平均住院費(fèi)用沒(méi)有差異。多因素分析顯示對(duì)住院分娩醫(yī)療費(fèi)用的主要影響因素有產(chǎn)后并發(fā)癥、分娩方式、病理妊娠、住院天數(shù)和年齡。3、該三級(jí)醫(yī)院生育保險(xiǎn)定額結(jié)算情況自然分娩組平均結(jié)余費(fèi)用為162.61元,結(jié)余比例為6.25%;人工干預(yù)分娩組平均結(jié)余費(fèi)用為121.97元,結(jié)余比例為4.69%;剖宮產(chǎn)組的平均結(jié)余費(fèi)用為136.32元,結(jié)余比例為2.96%;難產(chǎn)分娩組平均超支費(fèi)用為507.28元,超支比例為17.89%。結(jié)論:該三級(jí)醫(yī)院住院分娩醫(yī)療費(fèi)用由高到低依次為:藥品費(fèi)、手術(shù)麻醉費(fèi)、材料費(fèi)、治療費(fèi)、檢查費(fèi)、床位費(fèi)、其它費(fèi)、護(hù)理費(fèi)。影響住院分娩醫(yī)療費(fèi)用的主要因素有產(chǎn)后并發(fā)癥、分娩方式、病理妊娠、住院天數(shù)和年齡。該三級(jí)醫(yī)院的生育住院醫(yī)療費(fèi)用定額結(jié)算略有結(jié)余。
[Abstract]:Objective: to analyze the medical cost of in-hospital delivery of maternity insurance personnel, to understand the factors influencing the medical expenses of in-patient childbirth, to study the effect of each factor on the medical expenses of hospitalization, and to provide a reference for the effective management of maternity insurance. Methods: in 2013-2016, the insured persons of provincial straight birth insurance in a third class hospital in Taiyuan, Shanxi Province were studied. The HIS system was used to collect the information of discharge diagnosis, birth style, complications, number of births, expenses and so on from the hospital, and the related reimbursement data of the medical insurance office were consulted as a supplement. Age, occupation, mode of delivery, gestational week, pregnancy, pathological pregnancy, multiple pregnancy, hospitalization days, postpartum complications, hospitalization expenses (including bed fee, nursing fee, treatment fee, examination fee, operation anaesthesia fee, etc.) The cost of drugs, materials and other expenses were described statistically, and the relationship between the above factors and the medical expenses of hospital was analyzed by single factor analysis and multivariate analysis. Results: 1. The medical expenses of hospital delivery in the third level hospital are: drug cost, operation anaesthesia cost, material cost, treatment fee, examination fee, bed fee, other fee, nursing fee, etc. The cost of drugs, operating expenses and materials, which accounted for 76.78.2% of the total cost, were among the top three. The single factor analysis showed that the average medical cost of in-patient delivery in the elderly group was higher than that in the other age groups, and the single factor analysis showed that the average medical cost of in-hospital delivery was higher in the elderly group than in the other age groups. Cesarean section group was higher than difficult delivery group, artificial intervention group and natural delivery group, primiparous group was lower than transpartum group, pathological pregnancy group was higher than normal pregnancy group, multiple pregnancy group was higher than single pregnancy group. The postpartum complications group was higher than the non-complication group, and the more days of hospitalization, the higher the cost. There was no difference in average hospitalization expenses among different occupations and different gestational ages. Multivariate analysis showed that the main factors affecting medical expenses of hospitalized delivery were postpartum complications, delivery mode, pathological pregnancy, The average balance cost of the natural delivery group was 162.61 yuan, the balance ratio was 6.25 yuan, and the average balance cost of the artificial intervention delivery group was 121.97 yuan. The average cost of caesarean section was 136.32 yuan, the proportion of surplus was 2.96 yuan, the average cost of overspending was 507.28 yuan, the proportion of overspending was 17.89 yuan. Conclusion: the order of medical expenses of the hospital is: drug cost, operation anaesthesia cost, material cost, treatment fee, examination fee, bed fee, other fee, nursing fee. The main factors affecting medical expenses of hospitalized delivery were postpartum complications, delivery mode, pathological pregnancy, hospitalization days and age. The three-level hospital maternity hospitalization fee quota settlement slightly balance.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R197.32

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