本文選題：終末期腎病 + 血液透析�。� 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的本研究調(diào)查河南省、湖北省、湖南省、遼寧省、浙江省、江蘇省六省41家醫(yī)院,6008例終末期腎病血液透析和腹膜透析患者的基本情況、透析方式及透析費(fèi)用等,測算疾病直接經(jīng)濟(jì)負(fù)擔(dān)和間接經(jīng)濟(jì)負(fù)擔(dān),分析其疾病經(jīng)濟(jì)負(fù)擔(dān)的影響因素,以期能夠通過建議采用科學(xué)適宜的透析方式,最大限度地減輕其經(jīng)濟(jì)負(fù)擔(dān),避免“因病致貧、因病返貧”的發(fā)生,改善終末期腎病患者的生活質(zhì)量,幫助他們盡早回歸社會,為衛(wèi)生政策決策者制定相關(guān)政策提供依據(jù)和建議。方法采用現(xiàn)場問卷調(diào)查的方法,對血液透析和腹膜透析患者進(jìn)行回顧性調(diào)查,同時(shí)查閱病歷資料豐富調(diào)查內(nèi)容。調(diào)查內(nèi)容包括:人口社會學(xué)特征(患者性別、年齡、婚姻狀況、文化程度等),醫(yī)療費(fèi)用情況(透析費(fèi)用、腎病藥品費(fèi)、化驗(yàn)費(fèi)用、住院費(fèi)用、自付費(fèi)用、醫(yī)保報(bào)銷費(fèi)用等)。本研究使用Epidata 3.1建立數(shù)據(jù)庫,進(jìn)行數(shù)據(jù)的雙錄入,運(yùn)用SPSS 21.0進(jìn)行統(tǒng)計(jì)分析。結(jié)果(1)年齡組對比分析中,經(jīng)χ2檢驗(yàn),差異有統(tǒng)計(jì)學(xué)意義(P0.001)。血液透析患者年齡集中在50歲至69歲,占比為46.2%,患病人數(shù)隨年齡的增加呈現(xiàn)遞增趨勢,70歲以后患病人數(shù)減少。腹膜透析患者年齡集中在40歲至59歲,占比為51.2%。(2)原發(fā)病因?qū)Ρ确治鲋?經(jīng)χ2檢驗(yàn),差異無統(tǒng)計(jì)學(xué)意義(P=0.375)。原發(fā)病因前三順位分別是:慢性腎小球腎炎(39.6%)、糖尿病腎病(16.4%)、高血壓性腎病(14.2%)。血透原發(fā)病因依次是:慢性腎小球腎炎、高血壓性腎病和糖尿病腎病,腹透原發(fā)病因依次是:慢性腎小球腎炎、糖尿病腎病和高血壓性腎病。(3)參保情況分析中,經(jīng)χ2檢驗(yàn),差異有統(tǒng)計(jì)學(xué)意義(P0.001)。血透患者參加基本醫(yī)療保障的占比為93.83%,腹透患者參加基本醫(yī)療保障的占比為98.88%,其中參加城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)的血透患者多于腹透患者,參加新型農(nóng)村合作醫(yī)療的血透患者少于腹透患者。(4)疾病經(jīng)濟(jì)負(fù)擔(dān)對比分析中,經(jīng)秩和檢驗(yàn),差異有統(tǒng)計(jì)學(xué)意義(P0.001)。直接疾病經(jīng)濟(jì)負(fù)擔(dān)血液透析人均102000元,腹膜透析人均72400元;間接疾病經(jīng)濟(jì)負(fù)擔(dān)血液透析為649627元,腹透患者為634167元。血透均高于腹透。(5)在透析患者家庭經(jīng)濟(jì)負(fù)擔(dān)對比分析中,經(jīng)秩和檢驗(yàn),差異有統(tǒng)計(jì)學(xué)意義(P0.001)。血透在自付費(fèi)用、醫(yī)保報(bào)銷費(fèi)用、借債支付費(fèi)用、社會救助費(fèi)用等方面均值高于腹透。(6)不同省份、不同級別醫(yī)院直接經(jīng)濟(jì)負(fù)擔(dān)對比分析中,河南省、湖北省、湖南省的直接經(jīng)濟(jì)負(fù)擔(dān)高于浙江省、江蘇省、遼寧省,從透析方式看,各省血透直接經(jīng)濟(jì)負(fù)擔(dān)均高于腹透,且差距明顯。三級醫(yī)院血液透析費(fèi)用為108022元,腹透患者為71929元,血透與腹透費(fèi)用比例約為1:1.5。結(jié)論(1)終末期腎病患者的直接經(jīng)濟(jì)負(fù)擔(dān)和間接經(jīng)濟(jì)負(fù)擔(dān)腹膜透析均低于血液透析,血液透析患者人均直接經(jīng)濟(jì)負(fù)擔(dān)為102000元,間接經(jīng)濟(jì)負(fù)擔(dān)為649627元,腹膜透析患者人均直接經(jīng)濟(jì)負(fù)擔(dān)為72400元,間接經(jīng)濟(jì)負(fù)擔(dān)為634167元。血液透析經(jīng)濟(jì)負(fù)擔(dān)的主要影響因素為就醫(yī)醫(yī)院級別;腹膜透析經(jīng)濟(jì)負(fù)擔(dān)的主要影響因素為醫(yī)保類型。(2)血液透析疾病經(jīng)濟(jì)負(fù)擔(dān)浙江省、江蘇省醫(yī)保報(bào)銷比例高于且自付比例低于河南省、湖北省、湖南省和遼寧省。腹膜透析疾病經(jīng)濟(jì)負(fù)擔(dān)浙江省、湖南省醫(yī)保報(bào)銷比例高于其他省份,浙江省、河南省自付比例低于其他省份。醫(yī)保報(bào)銷比例及自付比例受到經(jīng)濟(jì)發(fā)展水平的影響。(3)隨著我國老齡化進(jìn)程加快,終末期腎病的老年發(fā)病人口群體大,患病人口趨于年輕化、低齡化,為切實(shí)減輕透析患者、醫(yī)保部門及全社會的疾病經(jīng)濟(jì)負(fù)擔(dān),就目前我國國情來看推廣腹透更具有現(xiàn)實(shí)意義,也更具有衛(wèi)生經(jīng)濟(jì)學(xué)意義。
[Abstract]:Objective to investigate 41 hospitals in six provinces of Henan, Hubei, Hunan, Liaoning, Zhejiang and Jiangsu, 6008 patients with end-stage renal disease, hemodialysis and peritoneal dialysis, to calculate the direct economic burden and indirect economic burden of the disease, and to analyze the factors affecting the economic burden of the disease. Through the suggestion of adopting a scientific and appropriate dialysis method, it can reduce its economic burden to the maximum extent, avoid the occurrence of "illness due to poverty and return to poverty", improve the quality of life of the patients with end-stage kidney disease, help them return to the society as soon as possible, and provide the basis and suggestions for the policy makers to formulate relevant policies. A retrospective survey of patients in hemodialysis and peritoneal dialysis was carried out in volume. The contents of the survey included the demographic characteristics of the population (gender, age, marital status, educational level, etc.), medical expenses (dialysis costs, nephrotic drug fees, laboratory costs, hospitalization costs, and self payment). This study used Epidata 3.1 to establish a database, double entry of data, and use SPSS 21 for statistical analysis. Results (1) in the age group comparison analysis, the difference was statistically significant (P0.001). The age of hemodialysis patients was from 50 to 69 years, accounting for 46.2%, and the number of patients was increased with age. The increasing trend was to decrease the number of patients after 70 years of age. The age of peritoneal dialysis patients was from 40 to 59 years old, and the proportion of 51.2%. (2) was compared. The difference was not statistically significant (P=0.375) by the chi 2 test. The first three cases were chronic glomerulonephritis (39.6%), diabetic nephropathy (16.4%), and hypertensive nephropathy (14.2%). The primary causes of hemodialysis were chronic glomerulonephritis, hypertensive nephropathy and diabetic nephropathy. The primary causes of peritoneal dialysis were chronic glomerulonephritis, diabetic nephropathy and hypertensive nephropathy. (3) the analysis of the insured conditions, the difference was statistically significant (P0.001). The proportion of patients with hemodialysis in basic medical security was 93.83%. The proportion of the patients who participated in the basic medical security was 98.88%, and the hemodialysis patients who participated in the basic medical insurance of the urban workers were more than those of the peritoneal dialysis. The patients who participated in the new rural cooperative medical treatment were less than those of the peritoneal dialysis. (4) in the comparative analysis of the economic burden of the disease, the difference was statistically significant (P0.001). 102000 yuan per capita for hemodialysis and 72400 yuan per capita in peritoneal dialysis, 649627 yuan for the economic burden of indirect disease and 634167 yuan for peritoneal dialysis. (5) in the comparative analysis of the family economic burden of dialysis patients, the difference has the significance of unified planning (P0.001) by rank sum test. The cost of blood dialysis at the expense of self payment and the reimbursement fee for medical insurance In different provinces, the direct economic burden of Henan Province, Hubei province and Hunan province is higher than that of Zhejiang, Jiangsu and Liaoning. The direct economic burdens of the provinces of Zhejiang, Jiangsu and Liaoning are higher than those of the peritoneal dialysis, and the difference between the direct economic burdens of all provinces is higher than that of the peritoneal dialysis, and the gap between the provinces is higher than that of the abdominal penetration. The cost of hemodialysis in the three level hospital was 108022 yuan, the peritoneal dialysis patient was 71929 yuan, the ratio of blood dialysis and peritoneal dialysis was about 1:1.5. conclusion (1) the direct economic burden and indirect economic burden of peritoneal dialysis in patients with end-stage renal disease were lower than those of hemodialysis. The direct economic burden of patients in hemodialysis patients was 102000 yuan, and the indirect economic burden was 6496. 27 yuan, the direct economic burden of the patients in peritoneal dialysis was 72400 yuan per capita and the indirect economic burden was 634167 yuan. The main influencing factors of the economic burden of hemodialysis were medical hospital level, the main influencing factor of the economic burden of peritoneal dialysis was the medical insurance type. (2) the burden of medical insurance for hemodialysis diseases was higher than that of Zhejiang Province, and the proportion of medical insurance reimbursement in Jiangsu province was higher than that of the medical insurance. The proportion of self payment is lower than that of Henan, Hubei, Hunan and Liaoning. The economic burden of peritoneal dialysis in Zhejiang Province, the proportion of medical insurance reimbursement in Hunan province is higher than that of other provinces, Zhejiang province and Henan province are lower than the other provinces. The proportion of medical insurance reimbursement and the proportion of self payment are influenced by the economic development level. (3) along with the accelerated aging process in China The population of the elderly with end-stage renal disease is large, the population of the disease tends to be younger, and the age of the disease is reduced. The economic burden of the medical insurance department and the whole society will be more practical, and it is of more significance to popularize the peritoneal dialysis in our country.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692.5;R197.1

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