遼寧省八家縣醫(yī)院新農(nóng)合腦梗死住院患者費(fèi)用支付研究
發(fā)布時(shí)間：2018-07-16 11:55
【摘要】：目的:通過對(duì)遼寧省八家縣醫(yī)院腦梗死住院患者醫(yī)療費(fèi)用進(jìn)行分析,了解住院費(fèi)用分布情況,尋找住院費(fèi)用影響因素,運(yùn)用統(tǒng)計(jì)學(xué)模型對(duì)費(fèi)用進(jìn)行分層管理,比較不同地區(qū)同種疾病不同費(fèi)用分層患者的疾病特點(diǎn)和費(fèi)用差異,為遼寧省新農(nóng)合費(fèi)用支付改革提供參考依據(jù)。方法:選自新農(nóng)合上報(bào)的2014年1月1日—12月31日期間腦梗死住院患者病案數(shù)據(jù)4156例作為研究對(duì)象。應(yīng)用SPSS統(tǒng)計(jì)軟件,對(duì)遼寧省八家縣級(jí)醫(yī)院腦梗死住院病人的住院費(fèi)用進(jìn)行分析,采用百分位數(shù)法對(duì)腦梗死費(fèi)用進(jìn)行分層和探討;采用相關(guān)分析、篩查出影響住院費(fèi)用的主要變量,并用多元線性回歸方法對(duì)住院費(fèi)用影響因素進(jìn)行分析。利用決策樹模型(CHAID),對(duì)不同費(fèi)用組患者進(jìn)行分類,尋找醫(yī)療費(fèi)用與患者疾病程度之間的關(guān)系。結(jié)果:1.腦梗死住院患者共計(jì)4156人,其中女性患者2137人,占51.4%,男性2019人,占48.6%;平均年齡66.3±10.6歲(27歲-98歲);年齡分段60-69歲人數(shù)最多;56.6%門診入院;70.6%患者合并有并發(fā)癥。2.不同醫(yī)院之間,8家醫(yī)療機(jī)構(gòu)中A醫(yī)院患者最多,占29.9%(1242人),E醫(yī)院最少,為1.3%(55人);性別方面,除了E醫(yī)院男性占72.7%(40人),女性占27.3%(15人),其他7家醫(yī)院男性比為45.8%-59.4%之間。女性比為40.6%-54.2%之間。年齡段分布,60歲以下各醫(yī)院占比H醫(yī)院最少,E醫(yī)院最高,80歲以上占比H醫(yī)院最多。3.腦梗死平均費(fèi)用6599.5±3850.5元(M=5961.5,IQR=3406.7);日均費(fèi)用655.0±338.6元(M=584.5,IQR=242),平均住院天數(shù)10.73天(M=11,IQR=7)。不同性別之間,女性平均住院日(10.9天)高于男性(10.5天)。隨著年齡段的增高,日均醫(yī)療費(fèi)用逐漸增多,總體來看,八家醫(yī)院之間平均住院日、平均住院費(fèi)用和日均費(fèi)用差異較大。4.八家縣醫(yī)院腦梗死費(fèi)用差異較大,平均費(fèi)用F醫(yī)院最高9070.7元,A醫(yī)院平均費(fèi)用最低5424.0元,其他六家醫(yī)療機(jī)構(gòu)在5759.4~7578.7元之間;從費(fèi)用分布來看,H醫(yī)院、B醫(yī)院、D醫(yī)院、C醫(yī)院高中低三組費(fèi)用分布比較均衡,但是高費(fèi)用分組各醫(yī)院費(fèi)用相差較大,F、E、G三家醫(yī)院高費(fèi)用組平均費(fèi)用均超過2萬元,其他5家醫(yī)院高費(fèi)用組均值在1萬~1.5萬之間,費(fèi)用差異達(dá)1倍以上。5.肺內(nèi)感染和糖尿病是病例分類的重要節(jié)點(diǎn)。6.腦梗死的住院影響因素有實(shí)際住院天數(shù)、入院途徑,有無糖尿病,有無肺內(nèi)感染,有無高血壓,年齡分段,其中離院方式、入院途徑呈負(fù)相關(guān)。結(jié)論:1.遼寧省8家縣級(jí)醫(yī)療機(jī)構(gòu)間腦梗死醫(yī)療費(fèi)用差異較大,影響醫(yī)保支付的公平性。2.肺內(nèi)感染,糖尿病是醫(yī)療費(fèi)用分層的重要節(jié)點(diǎn),但有8.2%的病例沒有任何并發(fā)癥卻出現(xiàn)在高費(fèi)用組,應(yīng)加強(qiáng)醫(yī)療服務(wù)行為監(jiān)管,確保新農(nóng)合基金的合理使用。3.住院天數(shù)、入院途徑,糖尿病、肺內(nèi)感染、高血壓以及年齡是醫(yī)療費(fèi)用的主要影響因素。4.不同醫(yī)院通過對(duì)費(fèi)用進(jìn)行分層管理,根據(jù)不同費(fèi)用分層患者的疾病特點(diǎn)和費(fèi)用差異進(jìn)行支付和監(jiān)管,可以減少一些不必要、不合理的診療行為,減少住院天數(shù),促進(jìn)醫(yī)�；鸷侠碛行褂�;同時(shí)維護(hù)了病情重、費(fèi)用高的患者醫(yī)療服務(wù)質(zhì)量,促進(jìn)醫(yī)療服務(wù)人員的積極性。
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.323;R743.33
本文編號(hào)：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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.323;R743.33
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