辽宁省彰武县新农合心脑血管疾病住院费用支出及影响因素
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摘要
目的:了解新农合心脑血管疾病的住院费用及报销现状,为控制医疗费用及制定报销政策提供参考。方法:对辽宁省彰武县2017年1月1日至2017年12月31日住院的参合者中患心脑血管疾病的住院费用进行描述性分析、单因素方差分析及多元逐步回归分析。结果:心脑血管疾病是彰武县参合者的主要慢性疾病,其中冠状动脉疾病所占比例最大。脑出血者人均医疗药费、个人自费及报销费用均高于其他疾病,其自费比例最高,为51.97%;肺源性心脏病的报销补偿比例最高,为69.46%;脑梗的药物花费比例最高,为40.50%;除冠状动脉疾病外其他疾病的人均住院费用在省级医院的花费最高;男性心脑血管疾病的住院费用均高于女性患者;性别、住院天数、医院级别及疾病类型是影响心脑血管疾病住院费用的主要因素(所有P<0.05)。结论:针对不同心脑血管疾病的医疗花费及经济负担,应依据疾病类型及严重程度,选择合理的就诊医院和有效的药物治疗,减少住院时间,以降低参合者心脑血管疾病的住院费用。
Objective: To understand the new rural cooperative medical care about the reimbursement and expenses of cardiovascular and cerebrovascular diseases and provide a reference basis for formulating reimbursement policies and controlling medical expenses Methods: The expenses of cardiovascular and cerebrovascular disease inpatients who joined the new rural cooperative medical care from January 1,2017 to December 31,2017 in Zhangwu County,Liaoning Province were analyzed by descriptive analysis,one-way ANOVA and multiple stepwise regression analysis. Results: In new rural cooperative medical care in Zhangwu,circulatory diseases are the major chronic diseases,cardiovascular and cerebrovascular diseases account for the largest proportion.Per capita medical expenses,personal expenses and reimbursement expenses for cerebral hemorrhage are higher than other diseases. Among them,the highest proportion of personal expenses is cerebral hemorrhage for 51.97%,the highest of reimbursement ratio is pulmonary heart disease for 69.46% and the highest proportion of drug costs is cerebral infarction for 40.50%. With the exception of cerebral infarction,the total medical expenses of other diseases are the highest in provincial hospitals. Inpatient medical expenses for male cardiovascular and cerebrovascular diseases are higher than female patients. The main factors affecting the cost of hospitalization for cardiovascular and cerebrovascular diseases were gender,hospitalization days,hospital level and disease type(all P< 0.05). Conclusion: The medical costs and economic burden for different cardiovascular and cerebrovascular diseases are different. According to the type and severity of the disease,choosing a reasonable hospital for treatment,choosing an effective drug for treatment,and reducing the length of stay can reduce the cost of inpatient hospital care for cardiovascular and cerebrovascular diseases.
Objective: To understand the new rural cooperative medical care about the reimbursement and expenses of cardiovascular and cerebrovascular diseases and provide a reference basis for formulating reimbursement policies and controlling medical expenses Methods: The expenses of cardiovascular and cerebrovascular disease inpatients who joined the new rural cooperative medical care from January 1,2017 to December 31,2017 in Zhangwu County,Liaoning Province were analyzed by descriptive analysis,one-way ANOVA and multiple stepwise regression analysis. Results: In new rural cooperative medical care in Zhangwu,circulatory diseases are the major chronic diseases,cardiovascular and cerebrovascular diseases account for the largest proportion.Per capita medical expenses,personal expenses and reimbursement expenses for cerebral hemorrhage are higher than other diseases. Among them,the highest proportion of personal expenses is cerebral hemorrhage for 51.97%,the highest of reimbursement ratio is pulmonary heart disease for 69.46% and the highest proportion of drug costs is cerebral infarction for 40.50%. With the exception of cerebral infarction,the total medical expenses of other diseases are the highest in provincial hospitals. Inpatient medical expenses for male cardiovascular and cerebrovascular diseases are higher than female patients. The main factors affecting the cost of hospitalization for cardiovascular and cerebrovascular diseases were gender,hospitalization days,hospital level and disease type(all P< 0.05). Conclusion: The medical costs and economic burden for different cardiovascular and cerebrovascular diseases are different. According to the type and severity of the disease,choosing a reasonable hospital for treatment,choosing an effective drug for treatment,and reducing the length of stay can reduce the cost of inpatient hospital care for cardiovascular and cerebrovascular diseases.
引文
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[15]李春燕,简伟研.中老年人心血管疾病经济负担——基于中国健康与养老追踪调查的实证分析[J].中国卫生政策研究,2017(5):75-80.
[16]韩红丽,王以新,张佩雪,等.浅谈冠心病患者门诊费用相关因素分析[J].继续医学教育,2018(2):88-91.
[17]郭亚璋.湖南湘西某医院医保职工2003~2007年住院费用及影响因素分析[D].中南大学,2008.
[18]刘述益,曹颖,李勇.五种常见老年慢性疾病住院医疗费用调查分析[J].四川医学,2017(11):1269-1273.
[2]周娇,郁芸,唐春燕,等. 2011-2013年东台市新农合住院病人疾病分析[J].安徽农业科学,2015,43(15):313-314.
[3]陈德喜,朱晓云,吕家爱,等.心脑血管疾病的危险因素[J].职业与健康,2017,33(15):2153-2156.
[4]孙欣欣,余正.心血管疾病患者住院费用研究综述[J].中国保健营养(下旬刊),2013(3):1583-1584.
[5]马培云,方鹏骞,乐虹.湖北省县级公立医院改革试点地区新农合基金运行管理状况分析[J].医学与社会,2016,29(4):20-23.
[6]贾志梅,庞雪蜂,王海龙,等.彰武县农村人群冠心病患病率及影响因素调查[J].中国公共卫生,2004(8):972-973.
[7]时景璞,李辉,付凌雨,等.辽宁省彰武县农村人群高血压患病率调查[J].中华流行病学杂志,2003(7):547-550.
[8]时景璞,滕卫禹,王海龙,等.高血压高发区人群脑卒中患病现状的流行病学调查[J].中国卫生统计,2006(1):47-49.
[9]时景璞,董卫,李辉,等.辽宁省彰武县农村人群高血压危险因素调查[J].中华流行病学杂志,2004(8):734.
[10]朱娟娟,刘萍,杨华,等.不同医保类型高血压患者住院费用对比分析[J].中国卫生质量管理,2015(1):41-44.
[11]刘沛,熊林平,王辉.新农合制度下农村慢性病患者住院费用实证分析[J].中国卫生事业管理,2014(7):525-527.
[12]马舒贝,吉训明,罗玉敏.脑出血的研究进展和治疗现状[J].中国脑血管病杂志,2015,12(5):272-276.
[13]王成,朱硕,陈晓燕,等.湖北省某县新型农村合作医疗住院服务过度需求病种分析[J].医学与社会,2013,26(4):18-20.
[14]刘石柱,詹长春,周绿林.医疗保险费用影响因素及控制对策[J].中国卫生经济,2012(8):33-35.
[15]李春燕,简伟研.中老年人心血管疾病经济负担——基于中国健康与养老追踪调查的实证分析[J].中国卫生政策研究,2017(5):75-80.
[16]韩红丽,王以新,张佩雪,等.浅谈冠心病患者门诊费用相关因素分析[J].继续医学教育,2018(2):88-91.
[17]郭亚璋.湖南湘西某医院医保职工2003~2007年住院费用及影响因素分析[D].中南大学,2008.
[18]刘述益,曹颖,李勇.五种常见老年慢性疾病住院医疗费用调查分析[J].四川医学,2017(11):1269-1273.