同级别医院住院费用影响因素研究
|
摘要
目的本文围绕同一级别综合性医院病种住院费用影响因素展开研究,找出可能的影响因素及其对住院费用的作用强度,并结合当前费用控制方法提出合理的费用控制思路。通过对比分析同级别医院的住院费用及其影响因素,探讨住院费用在同一级别医院的异同,为病种合理定价提供参考。
方法本文选择太原市两所二级甲等综合医院2009年全年出院的正常分娩和冠心病患者作为研究对象。数据资料来源于两院的病案室病历首页信息,剔除主要信息缺失的病例,符合标准的病例共589例,其中正常分娩201例(A院97例,B院104例),冠心病388例(A院176例,B院212例)。所有资料采用SPSS16.0进行统计分析。
结果(1)A、B两院在病人来源、住院费用构成等多种住院费用影响因素上均有不同程度差异；(2)医疗保险在两院产妇中的覆盖率较低,分别为27.84%和5.77%；(3)相同病种平均住院费用不同,两院正常分娩平均住院费用分别为2195.16元和2719.91元,冠心病分别为5741.16元和9313.22元；(4)影响住院费用最主要的因素是住院天数和药品费用比例；(5)有效控制病种住院费用的主要方法有：结合临床路径缩短平均住院日,控制药品使用、降低药品费用比例,加强管理、引导合理医疗消费。
结论育龄妇女参保情况值得关注；在衡量医院收费情况时,更应当关注收费结构的合理性而不仅仅是药品费用比例；同一病种即使在同等级医院,住院费用也不同,医保机构制定病种费率需考虑各种不可控因素；缩短住院天数和控制药费比例是控制费用的主要手段。
Objective This paper focus on the factors of inpatient costs between the same class of general hospital, to identify possible influence factors and the intensity of the factors, and provide the reasonable cost control methods.Through the comparative analysis to analyze the hospitalization expense of the same class and its influence factor, to discuss the hospitalization expense at the same class for the same disease, to analyze the differences of hospital charges between the same class of general hospital, to provide reference for reasonable hospitalization expenses.
Methods It chooses two upper second class general hospitals in Taiyuan,use single fetus natural delivery and coronary heart disease in 2009 as the sample.The data comes from the information of home page in the medical records, remove the single fetus natural delivery cases with secondary diagnosis and the cases of missing key information,standards-compliant patients were 589 cases, of which 201 patients with single fetus natural delivery (hospital A including 97 patients, hospital B 104 cases), coronary heart disease 388 (hospital A including 176 cases, hospital B including 212 cases). All data were analyzed by SPSS 16.0.
Results
(1) Both of the source of patient and inpatient cost structure have varying difference;
(2) The coverage of health insurance in two hospital were 27.84% and 5.77%;
(3) The same class hospital have different hospitalization costs, the average cost of single fetus natural delivery were 2,195.16 yuan and 2,719.91 yuan, coronary heart disease were 5,741.16 yuan and 9,313.22 yuan;
(4)The most important influence factors of the hospitalization cost is the length of stay and the proportion of drug expenses;
(5) The main effective methods of expenses control are:Combined with clinical trial to shorten the average length of stay, to control the drug use,to reduce the proportion of drug expenses, strengthen management, and to induce the rational health care consumption.
Conclusion The insurance in women of childbearing age should be solved;When measuring hospital charges in the case, it should focus on the reasonableness of the charge structure rather than the proportion of drug costs; The same disease even in the same class hospital still have different costs, the uncontrollable factors should be considered when health care institutions formulate the cost standards; Shorten the length of stay and control the cost of medicine are the main methods to control the hospital expenses.
方法本文选择太原市两所二级甲等综合医院2009年全年出院的正常分娩和冠心病患者作为研究对象。数据资料来源于两院的病案室病历首页信息,剔除主要信息缺失的病例,符合标准的病例共589例,其中正常分娩201例(A院97例,B院104例),冠心病388例(A院176例,B院212例)。所有资料采用SPSS16.0进行统计分析。
结果(1)A、B两院在病人来源、住院费用构成等多种住院费用影响因素上均有不同程度差异；(2)医疗保险在两院产妇中的覆盖率较低,分别为27.84%和5.77%；(3)相同病种平均住院费用不同,两院正常分娩平均住院费用分别为2195.16元和2719.91元,冠心病分别为5741.16元和9313.22元；(4)影响住院费用最主要的因素是住院天数和药品费用比例；(5)有效控制病种住院费用的主要方法有：结合临床路径缩短平均住院日,控制药品使用、降低药品费用比例,加强管理、引导合理医疗消费。
结论育龄妇女参保情况值得关注；在衡量医院收费情况时,更应当关注收费结构的合理性而不仅仅是药品费用比例；同一病种即使在同等级医院,住院费用也不同,医保机构制定病种费率需考虑各种不可控因素；缩短住院天数和控制药费比例是控制费用的主要手段。
Objective This paper focus on the factors of inpatient costs between the same class of general hospital, to identify possible influence factors and the intensity of the factors, and provide the reasonable cost control methods.Through the comparative analysis to analyze the hospitalization expense of the same class and its influence factor, to discuss the hospitalization expense at the same class for the same disease, to analyze the differences of hospital charges between the same class of general hospital, to provide reference for reasonable hospitalization expenses.
Methods It chooses two upper second class general hospitals in Taiyuan,use single fetus natural delivery and coronary heart disease in 2009 as the sample.The data comes from the information of home page in the medical records, remove the single fetus natural delivery cases with secondary diagnosis and the cases of missing key information,standards-compliant patients were 589 cases, of which 201 patients with single fetus natural delivery (hospital A including 97 patients, hospital B 104 cases), coronary heart disease 388 (hospital A including 176 cases, hospital B including 212 cases). All data were analyzed by SPSS 16.0.
Results
(1) Both of the source of patient and inpatient cost structure have varying difference;
(2) The coverage of health insurance in two hospital were 27.84% and 5.77%;
(3) The same class hospital have different hospitalization costs, the average cost of single fetus natural delivery were 2,195.16 yuan and 2,719.91 yuan, coronary heart disease were 5,741.16 yuan and 9,313.22 yuan;
(4)The most important influence factors of the hospitalization cost is the length of stay and the proportion of drug expenses;
(5) The main effective methods of expenses control are:Combined with clinical trial to shorten the average length of stay, to control the drug use,to reduce the proportion of drug expenses, strengthen management, and to induce the rational health care consumption.
Conclusion The insurance in women of childbearing age should be solved;When measuring hospital charges in the case, it should focus on the reasonableness of the charge structure rather than the proportion of drug costs; The same disease even in the same class hospital still have different costs, the uncontrollable factors should be considered when health care institutions formulate the cost standards; Shorten the length of stay and control the cost of medicine are the main methods to control the hospital expenses.
引文
[1]何平平,李连友.中国医疗费用增长的影响因素分析[J].统计与决策,2008(13)：74-76
[2]周旭东,赖瑞南.国外卫生费用决定因素的研究进展[J].《国外医学》卫生经济分册,2006,23(1)：2-6
[3]闭思成,刘艳兰.某三甲医院2002年与1993年住院病人医药费用比较分析[J].中国医院管理,2003,23(9)：41-42
[4]黄如意,胡善菊.供给诱导需求下的医疗费用增长问题分析[J].中国医疗前沿,2008,3(4)：43-44,46
[5]Jean M,Caroline M. DRG information system,health care reforms and innovation of management in the western countries.case-mix,2002, (4):16-19.
[6]Baker J.Medicare payment system for hospital inpatients:diagnosis-related groups.J Health Care Finance,2002,28:1-13.
[7]山西卫生厅承诺：推进50个病种单病种收费制度[EB/OL].http://sx.people.com.cn/GB/189133/11954819.html
[8]郑胡琴,陈玉芬.住院费用的现状分析与思考[J].统计与决策,2003(4)：57
[9]刘传木,周成超,田桂芬等.万元以上出院者住院费用分布及影响因素研究[J].中国卫生事业管理,2005,21(10)：628-630
[10]方积乾.生物医学研究的统计方法[M].北京：高等教育出版社,2007
[11]范炤.老年流行病学[M].北京：军事医学科学山版社,2008
[12]周艳.高龄妊娠对母儿结局影响的临床研究[D].上海：上海交通大学,2008
[13]王欣,马仁.腹腔镜胆囊切除术住院费用结算与疗效分析[J].中国现代医学杂志,2005，15(9)：2874-2875
[14]廖珊.1063例急性阑尾炎住院费用影响因素分析[J],中国医院统计,2003(12)：223-224
[15]陶红兵,郭石林,陈璞,等.临床路径的实施对医疗费用控制的影响研究[J].中国卫生经济,2008,27(2)：63-65.
[16]Markey,Mcgowan J.The effect of clinical pathway implementation on total hospital costs for thyroidectomy and parathyroidectomy patients[J].2000,66(6):533-539
[17]付映宏,刘越泽.临床路径在膝关节镜手术实施中的可行性分析[J].卫生软科学,2008,22(5)：335-337
[18]关华,黄颖烽,黄君瑶,等.临床路径在产科中的应用及成效[J].现代医院,2008,8(10)：121-122
[19]叶树俊,何忠正.胆石症和慢性肾炎临床路径应用的初步评价[J].江苏卫生事业管理,2009,4(20)：38-40
[20]郭齐祥,苑国辉.病种费用及质量控制研究[J].中国医院,2000(4)：229-230
[21]蒋日平.推行“以价招药”降低药品价格[J].卫生经济研究,2005,9：32-33
[22]柴瑞霁,李梅,范惠霞等.病种临床路径与费用控制研究报告[J].中国药物与临床,2009，9(3)：251-253
[23]汪丁丁.医生、医院、医疗体制改革[J].财经,2005,21：43-47
[24]鲁盛康,朱士俊,张迎媛等.北京地区16个常见病种DRGs病种费率测算[J].中华医院管理杂志,2008,24(3)：165-167
[1]何平平,李连友.中国医疗费用增长的影响因素分析[J].统计与决策,2008(13)：74-76
[2]周旭东,赖瑞南.国外卫生费用决定因素的研究进展[J].《国外医学》卫生经济分册,2006,23(1)：2-6
[3]闭思成,刘艳兰.某三甲医院2002年与1993年住院病人医药费用比较分析[J].中国医院管理,2003,23(9)：41-42
[4]黄如意,胡善菊.供给诱导需求下的医疗费用增长问题分析[J].中国医疗前沿,2008,3(4)：43-44,46
[5]王鸿勇.不同医疗费用支付方式的利弊分析及适宜制度选择[J].《国外医学》卫生经济分册,1998,15(1)：1-5
[6]王晓京,朱士俊.医疗费用支付方式的比较[J].中华医院管理杂志,2006,22(7)：481-483
[7]Robinson,J.C:Payment mechanism,non-price incentives,and organizational transaction in health Care[J]. Inquiry,1993,30 (3):328-333
[8]王丙毅.医疗付费机制的激励强度比较与现实选择[J].《国外医学》卫生经济分册,2008,25(4)：156-158
[9]Lim Angeline F,Tan,James S.Factors Influencing Length of Stay,Time to Resolution of Morbidity,and Cost of Patient Care:A Comparative Retrospective Study of Short-Stay and Long-Stay Patients Hospitalized for Simple Pneumonia(DRG 89 and 90) [J].Infectious Diseases in Clinical Practice,2001 October(7):375-383
[10]王梅,徐国恒.从病种医疗费用的研究谈医疗费用管理方式.中国卫生事业管理[J],2003(6)：332-335
[11]朱十俊,鲍玉荣.医疗费用支付方式改革—DRGs简介[J].中华医院管理杂志,2006,22(10)：664-665
[12]Baker JJ.Medicare payment system for hospital inpatients:diagnosis-related groups[J].Health Care Finance,2002 Spring,28(3):1-13
[13]洪国灿,姚诊.按病种定额付费制的可行性探讨[J].中国医院管理,2002,22(1)：14-16
[14]Saint S,Rose J,Lichter AS.Shifting costs from high-cost tolow-cost diagnosis-relatedgroups.Evaluation& the Health Professions[J],2002 Sep;25(3):259-269
[15]Martha Miranda,Lilia Cortez..The Diagnosis Related Groups (DRGs) to Adjust Payment-Mechanism for Health System Providers.CISS,Dec,2005:5-6
[16]Reid B,Palmer G,Aisbett C.The performance of Australian DRGs.Australian Health Review[J].2000, 23(2):20-31.
[17]Fantini MP,Cisbani L.On the use of administrative databases to support planning activities:the case of the evaluation of neonatal case-mix in the Emilia-Romagna region using DRG and APR-DRG classification systems.Europe Public Health[J],2003 Jun,13(2):138-145
[18]黄慧英.诊所相关分类法在北京地区医院管理中的可行性研究[J].中华医院管理杂志,1994,10(3),131-135，149
[19]徐勇勇,张音,潘峰,等.基于我国病案首页的病例组合方案与病例组合指数[J].中华医院管理杂志,2001，17(1)：34-36
[20]朱士俊,鲍玉荣,刘爱民,等.北京地区医院按DRGs付费和临床路径应用研究[J].中华医院管理杂志,2008,24(3)：145-147
[21]闰宇翔,罗艳侠,朱士俊,等.北京地区16个常见病种DRGs分组研究[J].中华医院管理杂志,2008,24(3)：168-174
[22]王鹏,陈仲强,胡牧.基于DRGs制定平均住院日指标的方法[J].中国医院,2009,13(5)：23-27
[23]秦安京.疾病分类编码准确是诊断相关分组(DRGs)的保障[J].中国病案,2007,8(7)：10-11
[24]陆慧编译,陈家应审校.美、澳、荷三国病例组合系统高编码风险比较研究[J].《国外医学》卫生经济分册,2008,25(99)：120-126
[25]付映宏,刘越泽.临床路径在膝关节镜手术实施中的可行性分析[J].卫生软科学,2008,22(5)：335-337
[26]关华,黄颖烽,黄君瑶,等.临床路径在产科中的应用及成效[J].现代医院,2008,8(10)：121-122
[27]叶树俊,何忠正.胆石症和慢性肾炎临床路径应用的初步评价[J].江苏卫生事业管理,2009,4(20)：38-40
[28]薛军,黄先涛.临床路径在胆囊结石腹腔镜胆囊切除术患者中应用的效果分析与探讨[J].2009,29(7)：41-43
[2]周旭东,赖瑞南.国外卫生费用决定因素的研究进展[J].《国外医学》卫生经济分册,2006,23(1)：2-6
[3]闭思成,刘艳兰.某三甲医院2002年与1993年住院病人医药费用比较分析[J].中国医院管理,2003,23(9)：41-42
[4]黄如意,胡善菊.供给诱导需求下的医疗费用增长问题分析[J].中国医疗前沿,2008,3(4)：43-44,46
[5]Jean M,Caroline M. DRG information system,health care reforms and innovation of management in the western countries.case-mix,2002, (4):16-19.
[6]Baker J.Medicare payment system for hospital inpatients:diagnosis-related groups.J Health Care Finance,2002,28:1-13.
[7]山西卫生厅承诺：推进50个病种单病种收费制度[EB/OL].http://sx.people.com.cn/GB/189133/11954819.html
[8]郑胡琴,陈玉芬.住院费用的现状分析与思考[J].统计与决策,2003(4)：57
[9]刘传木,周成超,田桂芬等.万元以上出院者住院费用分布及影响因素研究[J].中国卫生事业管理,2005,21(10)：628-630
[10]方积乾.生物医学研究的统计方法[M].北京：高等教育出版社,2007
[11]范炤.老年流行病学[M].北京：军事医学科学山版社,2008
[12]周艳.高龄妊娠对母儿结局影响的临床研究[D].上海：上海交通大学,2008
[13]王欣,马仁.腹腔镜胆囊切除术住院费用结算与疗效分析[J].中国现代医学杂志,2005，15(9)：2874-2875
[14]廖珊.1063例急性阑尾炎住院费用影响因素分析[J],中国医院统计,2003(12)：223-224
[15]陶红兵,郭石林,陈璞,等.临床路径的实施对医疗费用控制的影响研究[J].中国卫生经济,2008,27(2)：63-65.
[16]Markey,Mcgowan J.The effect of clinical pathway implementation on total hospital costs for thyroidectomy and parathyroidectomy patients[J].2000,66(6):533-539
[17]付映宏,刘越泽.临床路径在膝关节镜手术实施中的可行性分析[J].卫生软科学,2008,22(5)：335-337
[18]关华,黄颖烽,黄君瑶,等.临床路径在产科中的应用及成效[J].现代医院,2008,8(10)：121-122
[19]叶树俊,何忠正.胆石症和慢性肾炎临床路径应用的初步评价[J].江苏卫生事业管理,2009,4(20)：38-40
[20]郭齐祥,苑国辉.病种费用及质量控制研究[J].中国医院,2000(4)：229-230
[21]蒋日平.推行“以价招药”降低药品价格[J].卫生经济研究,2005,9：32-33
[22]柴瑞霁,李梅,范惠霞等.病种临床路径与费用控制研究报告[J].中国药物与临床,2009，9(3)：251-253
[23]汪丁丁.医生、医院、医疗体制改革[J].财经,2005,21：43-47
[24]鲁盛康,朱士俊,张迎媛等.北京地区16个常见病种DRGs病种费率测算[J].中华医院管理杂志,2008,24(3)：165-167
[1]何平平,李连友.中国医疗费用增长的影响因素分析[J].统计与决策,2008(13)：74-76
[2]周旭东,赖瑞南.国外卫生费用决定因素的研究进展[J].《国外医学》卫生经济分册,2006,23(1)：2-6
[3]闭思成,刘艳兰.某三甲医院2002年与1993年住院病人医药费用比较分析[J].中国医院管理,2003,23(9)：41-42
[4]黄如意,胡善菊.供给诱导需求下的医疗费用增长问题分析[J].中国医疗前沿,2008,3(4)：43-44,46
[5]王鸿勇.不同医疗费用支付方式的利弊分析及适宜制度选择[J].《国外医学》卫生经济分册,1998,15(1)：1-5
[6]王晓京,朱士俊.医疗费用支付方式的比较[J].中华医院管理杂志,2006,22(7)：481-483
[7]Robinson,J.C:Payment mechanism,non-price incentives,and organizational transaction in health Care[J]. Inquiry,1993,30 (3):328-333
[8]王丙毅.医疗付费机制的激励强度比较与现实选择[J].《国外医学》卫生经济分册,2008,25(4)：156-158
[9]Lim Angeline F,Tan,James S.Factors Influencing Length of Stay,Time to Resolution of Morbidity,and Cost of Patient Care:A Comparative Retrospective Study of Short-Stay and Long-Stay Patients Hospitalized for Simple Pneumonia(DRG 89 and 90) [J].Infectious Diseases in Clinical Practice,2001 October(7):375-383
[10]王梅,徐国恒.从病种医疗费用的研究谈医疗费用管理方式.中国卫生事业管理[J],2003(6)：332-335
[11]朱十俊,鲍玉荣.医疗费用支付方式改革—DRGs简介[J].中华医院管理杂志,2006,22(10)：664-665
[12]Baker JJ.Medicare payment system for hospital inpatients:diagnosis-related groups[J].Health Care Finance,2002 Spring,28(3):1-13
[13]洪国灿,姚诊.按病种定额付费制的可行性探讨[J].中国医院管理,2002,22(1)：14-16
[14]Saint S,Rose J,Lichter AS.Shifting costs from high-cost tolow-cost diagnosis-relatedgroups.Evaluation& the Health Professions[J],2002 Sep;25(3):259-269
[15]Martha Miranda,Lilia Cortez..The Diagnosis Related Groups (DRGs) to Adjust Payment-Mechanism for Health System Providers.CISS,Dec,2005:5-6
[16]Reid B,Palmer G,Aisbett C.The performance of Australian DRGs.Australian Health Review[J].2000, 23(2):20-31.
[17]Fantini MP,Cisbani L.On the use of administrative databases to support planning activities:the case of the evaluation of neonatal case-mix in the Emilia-Romagna region using DRG and APR-DRG classification systems.Europe Public Health[J],2003 Jun,13(2):138-145
[18]黄慧英.诊所相关分类法在北京地区医院管理中的可行性研究[J].中华医院管理杂志,1994,10(3),131-135，149
[19]徐勇勇,张音,潘峰,等.基于我国病案首页的病例组合方案与病例组合指数[J].中华医院管理杂志,2001，17(1)：34-36
[20]朱士俊,鲍玉荣,刘爱民,等.北京地区医院按DRGs付费和临床路径应用研究[J].中华医院管理杂志,2008,24(3)：145-147
[21]闰宇翔,罗艳侠,朱士俊,等.北京地区16个常见病种DRGs分组研究[J].中华医院管理杂志,2008,24(3)：168-174
[22]王鹏,陈仲强,胡牧.基于DRGs制定平均住院日指标的方法[J].中国医院,2009,13(5)：23-27
[23]秦安京.疾病分类编码准确是诊断相关分组(DRGs)的保障[J].中国病案,2007,8(7)：10-11
[24]陆慧编译,陈家应审校.美、澳、荷三国病例组合系统高编码风险比较研究[J].《国外医学》卫生经济分册,2008,25(99)：120-126
[25]付映宏,刘越泽.临床路径在膝关节镜手术实施中的可行性分析[J].卫生软科学,2008,22(5)：335-337
[26]关华,黄颖烽,黄君瑶,等.临床路径在产科中的应用及成效[J].现代医院,2008,8(10)：121-122
[27]叶树俊,何忠正.胆石症和慢性肾炎临床路径应用的初步评价[J].江苏卫生事业管理,2009,4(20)：38-40
[28]薛军,黄先涛.临床路径在胆囊结石腹腔镜胆囊切除术患者中应用的效果分析与探讨[J].2009,29(7)：41-43