2001-2016年广州市某三甲医院肝癌住院患者费用影响因素分析
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摘要
目的近年来,居民的医疗保健支出不断增加,肝癌患者经济负担沉重。本研究分析肝癌患者医疗费用的变化规律和影响因素,为合理控制肝癌患者的医疗费用提供依据。方法选取广州市某三甲医院2001-01-01-2016-12-31肝癌住院患者8 623例,分析其住院费用的变化趋势及构成情况,根据四分位数将平均住院费用分为4个等级作为因变量,采用Logistic回归分析其主要影响因素。结果 2001-2016年,肝癌住院患者平均住院天数从22.680d减少至14.410d,经居民消费价格指数(consumer price index,CPI)调整后平均住院费用从50 036.566元下降至43 375.471元。药品费占住院费用的比重最大,为44.39%,其次是诊疗费(28.00%)、检查费(10.42%)。多因素Logistic回归分析结果显示,住院年份(χ~2=410.490,P<0.001)、患者来源(χ~2=41.096,P<0.001)、住院天数(χ~2=3 889.488,P<0.001)、是否手术(χ~2=711.744,P<0.001)、疗效(χ~2=213.398,P<0.001)是肝癌患者住院费用的影响因素。以住院费用四分位为因变量,采用多分类的Logistic回归分析结果显示,与2013-2016年相比,在住院费用≤25%中,住院年份OR2001-2004=393.741(95%CI:165.719～935.510),OR2005-2008=75.458(95%CI:34.162～166.674),OR2009-2012=9.103(95%CI:4.334～19.118);在住院费用26%～50%中,住院年份OR2001-2004=70.747(95%CI:33.086～151.277),OR2005-2008=19.380(95%CI:9.544～39.353),OR2009-2012=3.529(95%CI:1.815～6.861);在住院费用51%～75%中,住院年份OR2001-2004=11.343(95%CI:5.932～21.689),OR2005-2008=4.949(95%CI:2.695～9.088),OR2009-2012=1.695(95%CI:0.953～3.016)。结论自2001年以来,肝癌患者住院费用不断上升,CPI调整后住院费用总体呈下降趋势,影响住院费用的主要因素已经初步得到控制,患者的经济负担相对减轻。
OBJECTIVE Medical expenditure has been increased and the liver cancer has resulted in a heavy economic burden.This study aimed to analyze the changes in hospitalization costs and influencing factors of in-patients with liver cancer,and provide theoretical evidences for the control of medical expenditure.METHODS After data pre-processing,8 623 lung cancer in-patients with liver cancer who was hospitalized in a certain 3 Ahospital in Guangzhou from January 1 st,2001 to December 31 th,2016 were included.A description of the hospitalization costs was made and logistic regression was used to analyze the influencing factors of hospitalization costs.RESULTS From 2001 to 2016,the mean hospital stay was decreased from 22.680 days to 14.410 days,Adjusted by consumer price index(CPI),the hospitalization expenditure was decreased from 50 036.566 RMB to 43 375.471 RMB.The medicine expense(44.39%)accounted for the largest proportion of the hospitalization expenditure,followed by the physician fee(28.00%)and examination fee(10.42%).The year of hospitalization(χ~2=410.490,P<0.001),the source of patients(χ~2=41.096,P<0.001),the mean hospital stay(χ~2=3 889.488,P<0.001),with or without surgery(χ~2=711.744,P<0.001)and curative effect(χ~2=213.389,P<0.001)were significantly associated with the hospitalization costs.Comparing the hospital expenditure below 25% in 2013-2016,the results were OR2001-2004=393.741(95%CI:165.719-935.510),OR2005-2008=75.458(95%CI:34.162-166.674),OR2009-2012=9.103(95%CI:4.334-19.118).As for the hospital expenditure between 26%and 50%,comparing the period in 2013-2016,the results were OR2001-2004=70.747(95%CI:33.086-151.277),OR2005-2008=19.380(95%CI:9.544-39.353),OR2009-2012=3.529(95%CI:1.815-6.861).For the hospital expenditure between 51% and 75%in 2013-2016,the results were OR2001-2004=11.343(95%CI:5.932-21.689),OR2005-2008=4.949(95%CI:2.695-9.088),OR2009-2012=1.695(95%CI:0.953-3.016).CONCLUSIONS The hospitalization expenditure of in-patients with liver cancer from 2001 to 2016 in Guangzhou was increased,while adjusted by CPI,the hospitalization costs were decreased generally.These illustrate that the main influencing factors of the expenditure has been preliminarily controlled,and the financial burden of in-patients has been relatively reduced since 2001.
OBJECTIVE Medical expenditure has been increased and the liver cancer has resulted in a heavy economic burden.This study aimed to analyze the changes in hospitalization costs and influencing factors of in-patients with liver cancer,and provide theoretical evidences for the control of medical expenditure.METHODS After data pre-processing,8 623 lung cancer in-patients with liver cancer who was hospitalized in a certain 3 Ahospital in Guangzhou from January 1 st,2001 to December 31 th,2016 were included.A description of the hospitalization costs was made and logistic regression was used to analyze the influencing factors of hospitalization costs.RESULTS From 2001 to 2016,the mean hospital stay was decreased from 22.680 days to 14.410 days,Adjusted by consumer price index(CPI),the hospitalization expenditure was decreased from 50 036.566 RMB to 43 375.471 RMB.The medicine expense(44.39%)accounted for the largest proportion of the hospitalization expenditure,followed by the physician fee(28.00%)and examination fee(10.42%).The year of hospitalization(χ~2=410.490,P<0.001),the source of patients(χ~2=41.096,P<0.001),the mean hospital stay(χ~2=3 889.488,P<0.001),with or without surgery(χ~2=711.744,P<0.001)and curative effect(χ~2=213.389,P<0.001)were significantly associated with the hospitalization costs.Comparing the hospital expenditure below 25% in 2013-2016,the results were OR2001-2004=393.741(95%CI:165.719-935.510),OR2005-2008=75.458(95%CI:34.162-166.674),OR2009-2012=9.103(95%CI:4.334-19.118).As for the hospital expenditure between 26%and 50%,comparing the period in 2013-2016,the results were OR2001-2004=70.747(95%CI:33.086-151.277),OR2005-2008=19.380(95%CI:9.544-39.353),OR2009-2012=3.529(95%CI:1.815-6.861).For the hospital expenditure between 51% and 75%in 2013-2016,the results were OR2001-2004=11.343(95%CI:5.932-21.689),OR2005-2008=4.949(95%CI:2.695-9.088),OR2009-2012=1.695(95%CI:0.953-3.016).CONCLUSIONS The hospitalization expenditure of in-patients with liver cancer from 2001 to 2016 in Guangzhou was increased,while adjusted by CPI,the hospitalization costs were decreased generally.These illustrate that the main influencing factors of the expenditure has been preliminarily controlled,and the financial burden of in-patients has been relatively reduced since 2001.
引文
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[2]中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].传染病信息,2017,16(3):705-720.
[3]王黎君,殷鹏,刘韫宁,等.1990年与2013年中国人群肝癌疾病负担研究[J].中华流行病学杂志,2016,37(6):758-762.
[4]邵海妍,彭民金,陈功,等.1991-2011年中国肝癌死亡趋势的APC模型分析[J].中华肿瘤防治杂志,2016,23(22):1465-1469.
[5]Zheng Z,Wang L,Fu Q,et al.Analysis of the effect of medical insurance on cancer inpatients:a 10-year retrospective study on a large hospital in northeast China[J].Oncol Transl Med,2015,1(6):284-288.
[6]Xu Y,Li N,Lu M,et al.The effects of patient cost sharing on inpatient utilization,cost,and outcome[EB/OL].PLoS One,2017,12(10):e187096[2018-05-19].https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187096.
[7]许长栋,柴培培,张毓辉,等.2010年我国恶性肿瘤防治费用分析[J].中国卫生经济,2014,33(6):24-26.
[8]Lang K,Danchenko N,Gondek K,et al.The burden of illness associated with hepatocellular carcinoma in the United States[J].JHepatol,2009,50(1):89-99.
[9]张业繁,郭兰伟,白方舟,等.中国肝癌患者2002~2011年日均医疗费用趋势分析:多中心回顾性调查[J].中国循证医学杂志,2018,18(5):1-8.
[10]朱瑞凯,冯向先,杨辉,等.886例乳腺癌病人住院费用影响因素分析[J].中华疾病控制杂志,2014,18(3):247-251.
[11]冷家骅,刘忆,刘晶,等.结直肠肿瘤手术患者DRGs分组效果与费用分析[J].中国卫生经济,2017,36(5):29-32.
[12]高志蕊.医疗行为与物价管理对医保总额控制的影响分析[J].中国国际财经(中英文),2017,31(20):196.
[13]王志刚.中国物价变化的实证分析及走势预测[J].价格理论与实践,2016,18(12):17-21.
[14]张毓辉,万泉,王秀峰,等.2009-2014年中国卫生总费用分析[J].中国卫生经济,2016,35(3):5-8.
[15]方鹏骞,李璐,李文敏,等.我国公立医院改革进展、面临的挑战及展望[J].中国医院管理,2012,32(1):1-5.
[16]章娣,林振平,张昕,等.2006-2013年某医院肝癌患者住院费用的影响因素分析[J].国外医学卫生经济分册,2016,33(3):123-126.
[17]王强,刘晓阳,化建彪,等.西北某县2012-2015年肝癌出院患者住院费用的变化及影响因素分析[J].现代医院,2018,18(6):836-838.
[18]李潇,方一清,王敏,等.2015年某院肿瘤化疗住院患者疾病构成和费用分析[J].中国病案,2017,18(9):63-66.
[19]崔鑫宇,程永忠.某医院3 364例肺癌患者住院费用情况及影响因素分析[J].现代预防医学,2017,44(17):3159-3162.
[20]肖海帆,廖先珍,许可葵,等.2002~2014年1 542例肺癌患者住院费用分析[J].中国肿瘤,2016,25(5):338-344.
[21]徐婷婷,冯俊,覃娴静,等.2014-2016年广西三甲综合医院住院费用结构变动情况分析[J].现代预防医学,2018,44(10):1809-1811.
[22]冯俊,李英利,徐婷婷,等.基于结构变动度的三甲综合医院2014~2016年住院费用结构评价[J].中国医药导报,2018,38(13):147-150.
[23]王越,吴硕,张斌,等.医疗服务价格调整对医保住院患者费用结构的影响[J].中国医疗保险,2018,11(9):49-53.
[24]陈治水,冷家骅,高广颖,等.五类肿瘤疾病住院费用及其影响因素分析[J].中国卫生经济,2014,33(7):57-60.
[25]周艳,蔡艳,赵霞,等.基于临床路径的五病种住院费用分析[J].中国病案,2011,12(9):28-30.
[26]陈民,宋欢,王金龙,等.江苏省三级乙等医院肺结核患者住院费用分析[J].现代预防医学,2017,43(2):275-277.
[27]石春雷,娄培安,董宗美,等.徐州市三级综合医院2007-2013年肺癌患者住院费用分析[J].中华肿瘤防治杂志,2017,24(17):1183-1189.
[28]董佩,毛阿燕,邱五七,等.北京市本地与外地肺癌患者就诊及医疗费用分析[J].中国病案,2017,18(1):47-50.
[29]宋霖婧,毛阿燕,董佩,等.跨区域就医管理浅析:以北京市肿瘤患者为例[J].中国卫生事业管理,2018,34(2):81-85.
[30]张燕,胡凯,邱杰.某三甲医院医保与自费胃部恶性肿瘤病人住院费用调查分析[J].中国病案,2010,11(1):9-11.
[2]中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].传染病信息,2017,16(3):705-720.
[3]王黎君,殷鹏,刘韫宁,等.1990年与2013年中国人群肝癌疾病负担研究[J].中华流行病学杂志,2016,37(6):758-762.
[4]邵海妍,彭民金,陈功,等.1991-2011年中国肝癌死亡趋势的APC模型分析[J].中华肿瘤防治杂志,2016,23(22):1465-1469.
[5]Zheng Z,Wang L,Fu Q,et al.Analysis of the effect of medical insurance on cancer inpatients:a 10-year retrospective study on a large hospital in northeast China[J].Oncol Transl Med,2015,1(6):284-288.
[6]Xu Y,Li N,Lu M,et al.The effects of patient cost sharing on inpatient utilization,cost,and outcome[EB/OL].PLoS One,2017,12(10):e187096[2018-05-19].https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187096.
[7]许长栋,柴培培,张毓辉,等.2010年我国恶性肿瘤防治费用分析[J].中国卫生经济,2014,33(6):24-26.
[8]Lang K,Danchenko N,Gondek K,et al.The burden of illness associated with hepatocellular carcinoma in the United States[J].JHepatol,2009,50(1):89-99.
[9]张业繁,郭兰伟,白方舟,等.中国肝癌患者2002~2011年日均医疗费用趋势分析:多中心回顾性调查[J].中国循证医学杂志,2018,18(5):1-8.
[10]朱瑞凯,冯向先,杨辉,等.886例乳腺癌病人住院费用影响因素分析[J].中华疾病控制杂志,2014,18(3):247-251.
[11]冷家骅,刘忆,刘晶,等.结直肠肿瘤手术患者DRGs分组效果与费用分析[J].中国卫生经济,2017,36(5):29-32.
[12]高志蕊.医疗行为与物价管理对医保总额控制的影响分析[J].中国国际财经(中英文),2017,31(20):196.
[13]王志刚.中国物价变化的实证分析及走势预测[J].价格理论与实践,2016,18(12):17-21.
[14]张毓辉,万泉,王秀峰,等.2009-2014年中国卫生总费用分析[J].中国卫生经济,2016,35(3):5-8.
[15]方鹏骞,李璐,李文敏,等.我国公立医院改革进展、面临的挑战及展望[J].中国医院管理,2012,32(1):1-5.
[16]章娣,林振平,张昕,等.2006-2013年某医院肝癌患者住院费用的影响因素分析[J].国外医学卫生经济分册,2016,33(3):123-126.
[17]王强,刘晓阳,化建彪,等.西北某县2012-2015年肝癌出院患者住院费用的变化及影响因素分析[J].现代医院,2018,18(6):836-838.
[18]李潇,方一清,王敏,等.2015年某院肿瘤化疗住院患者疾病构成和费用分析[J].中国病案,2017,18(9):63-66.
[19]崔鑫宇,程永忠.某医院3 364例肺癌患者住院费用情况及影响因素分析[J].现代预防医学,2017,44(17):3159-3162.
[20]肖海帆,廖先珍,许可葵,等.2002~2014年1 542例肺癌患者住院费用分析[J].中国肿瘤,2016,25(5):338-344.
[21]徐婷婷,冯俊,覃娴静,等.2014-2016年广西三甲综合医院住院费用结构变动情况分析[J].现代预防医学,2018,44(10):1809-1811.
[22]冯俊,李英利,徐婷婷,等.基于结构变动度的三甲综合医院2014~2016年住院费用结构评价[J].中国医药导报,2018,38(13):147-150.
[23]王越,吴硕,张斌,等.医疗服务价格调整对医保住院患者费用结构的影响[J].中国医疗保险,2018,11(9):49-53.
[24]陈治水,冷家骅,高广颖,等.五类肿瘤疾病住院费用及其影响因素分析[J].中国卫生经济,2014,33(7):57-60.
[25]周艳,蔡艳,赵霞,等.基于临床路径的五病种住院费用分析[J].中国病案,2011,12(9):28-30.
[26]陈民,宋欢,王金龙,等.江苏省三级乙等医院肺结核患者住院费用分析[J].现代预防医学,2017,43(2):275-277.
[27]石春雷,娄培安,董宗美,等.徐州市三级综合医院2007-2013年肺癌患者住院费用分析[J].中华肿瘤防治杂志,2017,24(17):1183-1189.
[28]董佩,毛阿燕,邱五七,等.北京市本地与外地肺癌患者就诊及医疗费用分析[J].中国病案,2017,18(1):47-50.
[29]宋霖婧,毛阿燕,董佩,等.跨区域就医管理浅析:以北京市肿瘤患者为例[J].中国卫生事业管理,2018,34(2):81-85.
[30]张燕,胡凯,邱杰.某三甲医院医保与自费胃部恶性肿瘤病人住院费用调查分析[J].中国病案,2010,11(1):9-11.