华西医院1635例汶川地震住院患者总体费用构成和影响因素分析
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摘要
目的了解华西医院汶川地震患者医疗费用构成及其影响因素,为国家制定和拨付医疗费用标准及评估地震医疗救治成本–效果提供参考。方法收集截至2008年7月4日医院已出院并诊断明确的地震患者,统计其总医疗费用及各分类费用,并分析医疗费用的影响因素。统计分析采用SPSS13.0软件,费用采用X±SD描述,费用分类比较采用秩和检验、影响因素分析采用多元线性回归分析。结果共纳入1635例出院地震患者,包括地震伤员1413例(86.04%)、灾区病人222例(13.96%)。住院地震患者人均费用为9165.05±12426.11元,费用构成主要为手术及其相关费用(包括材料费、检查费、治疗费),占71.75%,药品费仅占18.41%,床位费和其他费用不足10%。病种分类费用构成中,灾区病人高于地震伤员(Z=–4.109,P=0.000),而地震伤员分类费用显示,手术和医疗并发症、多部位损伤和地震次生灾害所致的损伤如烧伤和腐蚀伤是造成高费用的直接原因。影响住院总费用的因素包括是否手术(r=0.386)、是否住ICU(r=0.336)和住院天数(r=0.246)。结论华西医院汶川地震住院患者以地震伤员为主,其费用构成主要为与手术相关的费用,高费用为并发症、多部位损伤和次生灾害所致损伤,住院总费用与是否手术、是否住ICU和住院天数相关,与性别无关,与年龄和转归间的关系尚待进一步研究,而与病种的关系很大程度上受分类标准的影响。
Objective To explore the structure and influencing factors of overall medical treatment expenses of 1 635 inpatients of Wenchuan earthquake in West China Hospital and to provide references for setting up the criteria of medical expenses and for assess the cost-effect of medical rescue and treatment. Methods The data of earthquake casualties were collected to analyze the constitution and influencing factors of the overall medical expense by SPSS 13.0 software. The data were described by X±SD. Comparison of data categories was tested by rank sum and influencing factors were analyzed by multiple linear regression analysis. Results A total of 1 635 casualties including 1 413 (86.04%) earthquake wounded and 222 (13.96%) patients from the disaster area were identified. The average expense per capita was 9 165.05±12 426.11 yuan. The overall cost was made up of operation expenses (71.75%) including material cost, examination fee and treatment fee, drug cost (18.41%) as well as bed fee and others (less than 10%). The cost of patients from the disaster area was higher than that of the earthquake wounded (Z= –4.109, P=0.000). The operation, complications, multiple-site damages, injures induced by the secondary disaster of the earthquake such as burn and corrosion were the direct reason leading to the high overall expense. The influencing factors included operation (r=0.386), ICU (r=0.336) and the day of hospitalization (r=0.246). Conclusion The earthquake wounded occupy the predominant percentage of the earthquake inpatients in West China Hospital. The operation, complications, multiple-site damages and injures induced by the secondary disaster of the earthquake lead to a high overall expense. The influencing factors include operation, ICU and the day of hospitalization. The relationship between the expense and the disease category largely depends on the classification criteria. The relationship between the expense and the age as well as the prognosis needs further study. But no correlation between the expense and the gender is found.
Objective To explore the structure and influencing factors of overall medical treatment expenses of 1 635 inpatients of Wenchuan earthquake in West China Hospital and to provide references for setting up the criteria of medical expenses and for assess the cost-effect of medical rescue and treatment. Methods The data of earthquake casualties were collected to analyze the constitution and influencing factors of the overall medical expense by SPSS 13.0 software. The data were described by X±SD. Comparison of data categories was tested by rank sum and influencing factors were analyzed by multiple linear regression analysis. Results A total of 1 635 casualties including 1 413 (86.04%) earthquake wounded and 222 (13.96%) patients from the disaster area were identified. The average expense per capita was 9 165.05±12 426.11 yuan. The overall cost was made up of operation expenses (71.75%) including material cost, examination fee and treatment fee, drug cost (18.41%) as well as bed fee and others (less than 10%). The cost of patients from the disaster area was higher than that of the earthquake wounded (Z= –4.109, P=0.000). The operation, complications, multiple-site damages, injures induced by the secondary disaster of the earthquake such as burn and corrosion were the direct reason leading to the high overall expense. The influencing factors included operation (r=0.386), ICU (r=0.336) and the day of hospitalization (r=0.246). Conclusion The earthquake wounded occupy the predominant percentage of the earthquake inpatients in West China Hospital. The operation, complications, multiple-site damages and injures induced by the secondary disaster of the earthquake lead to a high overall expense. The influencing factors include operation, ICU and the day of hospitalization. The relationship between the expense and the disease category largely depends on the classification criteria. The relationship between the expense and the age as well as the prognosis needs further study. But no correlation between the expense and the gender is found.
引文
1刘丹红,陈平,徐勇勇.临床疾病严重度评价标准.中国医院统计,2002,9(2):78-80.
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