本文選題：腦卒中 + 醫(yī)療保險　； 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 探討天津市參加城鎮(zhèn)職工、城鄉(xiāng)居民基本醫(yī)療保險的腦卒中患者住院費用構(gòu)成、個人負擔(dān)率及醫(yī)保政策對其影響。為保障醫(yī)療保險基金的合理使用,控制醫(yī)療費用、降低患者的自費率,減輕患者經(jīng)濟負擔(dān)提供參考依據(jù)。 方法 從天津市參加城鎮(zhèn)職工、城鄉(xiāng)居民基本醫(yī)療保險的住院患者數(shù)據(jù)庫中整群抽取2010年1月1日～2012年12月31日三級醫(yī)療機構(gòu)腦卒中患者146826例,觀察不同性別、年齡、卒中亞型、住院日及預(yù)后對住院費用的影響,分析住院費用的主要結(jié)構(gòu)；同時選取兩所醫(yī)療機構(gòu)腦卒中患者26613例,觀察不同險種、卒中亞型對個人負擔(dān)率的影響,分析自費部分的主要結(jié)構(gòu)。研究使用Excel2003建立數(shù)據(jù)庫,用SPSS17.0軟件進行統(tǒng)計學(xué)分析。 結(jié)果 缺血性腦卒中患者127090例,多于出血性腦卒中。男性患者87666例,占59.71%,高于女性(χ2=72.31,P0.001)。缺血性腦卒中患者的平均年齡為65.83±11.38歲,高于出血性腦卒中患者(t=17.47,P0.001)。缺血性腦卒中疾病總費用180061.14萬元,占腦卒中社會經(jīng)濟負擔(dān)的77.72%。出血性腦卒中次均費用2.61±3.34萬元,高于缺血性腦卒中。老年組缺血性腦卒中69074例,占47.04%；發(fā)生費用100814.37萬元,占55.99%,所占比例最多。住院日中位數(shù)14天,住院費用中位數(shù)1.21萬元,患者住院日與發(fā)生費用呈正相關(guān)。住院費用中藥品費114837.22萬元,占49.56%,比例最高。死亡組的次均費用為3.39±2.04萬元,高于治愈好轉(zhuǎn)組(t=53.64,P0.001)。 兩所醫(yī)療機構(gòu)腦卒中住院患者的人次均費用1.87±2.14萬元,高于天津市三級醫(yī)療機構(gòu)的平均水平。城職患者平均年齡64.07±11.44歲(t=6.84,P0.001)、平均住院日113.65±9.15天(t=18.18,P0.001)、次均費用1.89±2.26萬元(t=2.77,P=0.006)均高于城鄉(xiāng)患者。兩所醫(yī)療機構(gòu)的平均個人負擔(dān)率49.20%,高于天津市三級醫(yī)療機構(gòu)。城鄉(xiāng)居民個人負擔(dān)率為68.37%,大于城職患者。城職患者自費金額占實際自負的62.29%,大于城鄉(xiāng)患者；城鄉(xiāng)患者政策性自負金額占實際自負的56.38%,大于城職患者。城職、城鄉(xiāng)患者自費總額中藥品費占比分別為27.31%、28.90%,對自費構(gòu)成影響因素最大。自費結(jié)構(gòu)在費用組成中的影響因素依次為藥品費、醫(yī)用材料費、治療費和檢查費。 結(jié)論 通過對天津市三級醫(yī)療機構(gòu)腦卒中住院患者的費用研究,我們得出如下結(jié)論：男性缺血性腦卒中患者占腦卒中總費用最高；出血性腦卒中患者平均經(jīng)濟負擔(dān)高于缺血性腦卒中患者；老年組缺血性腦卒中患者住院例數(shù)及發(fā)生費用占腦卒中比重最大,應(yīng)重點關(guān)注。 兩所醫(yī)療機構(gòu)腦卒中住院患者的個人負擔(dān)率明顯高于天津市三級醫(yī)療機構(gòu)。城鄉(xiāng)患者個人負擔(dān)率偏高,結(jié)構(gòu)不合理。應(yīng)重點調(diào)控自費藥品及醫(yī)用材料費。
[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 鹵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 鹵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 鹵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 鹵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 鹵11.44 years old, the average hospitalization days were 113.65 鹵9.15 days, the average cost was 1.89 鹵22600 yuan, and the average cost was 1.89 鹵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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3

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