城镇基本医疗肝癌患者住院费用结构及影响因素分析
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摘要
目的通过分析原发性肝癌患者住院费用的影响因素进行,为减轻患者医疗经济负担提供依据。方法从住院日期为2016年1月～2017年6月南宁市城镇职工医疗保险数据库中抽取诊断为原发性肝癌的全部出院记录共209例作为研究对象,采用描述性分析、多重线性回归方法对肝癌患者住院费用的结构和影响因素进行分析。结果肝癌患者各项费用在住院总费用中的占比分别为药费40.00%、材料费22.27%、检查费13.78%、化验费11.70%以及治疗费11.10%。住院费用的主要影响因素有是否手术、住院天数、年龄、性别、第几次入院以及是否启动大病保险(P <0.05)。结论住院天数、是否手术、性别、年龄、第几次入院以及是否启动大病保险是住院总费用的影响因素。针对肝癌患者经济负担较重的情况,建议城镇职工基本医疗保险经办机构及医院采取单病种付费,促使医院在利益上节约成本,缩短患者住院时间,减少医疗资源浪费。
Objective To analyze the influencing factors of hospitalization expenses of patients with primary liver cancer, and provide evidence for reducing the medical economic burden of patients. Methods In Nanning medical insurance for urban workers database, 209 discharge records diagnosed as primary liver cancer from January 2016 to June2017 were collected. The descriptive analysis and multiple linearity regression were used to analyze the structure and influencing factors of hospitalization expenses for patients with liver cancer. Results The proportion of various expenses in the total hospitalization expenses of liver cancer patients were 40.00% of medicine costs, 22.27% of materials costs,13.78% of inspection fees, 11.70% of laboratory expenses, and 11.10% of treatment expenses. The main influencing factors of hospitalization expenses were whether surgery, hospitalization days, age, gender, number of hospitalizations,and whether using critical illness insurance. Conclusion Hospitalization days, whether surgery, gender, age, number of hospitalizations, and whether or not to use critical illness insurance are factors influencing the total cost of hospitalization. In view of the heavier economic burden of liver cancer patients, it is recommended that the agencies of medical insurance for urban employees and hospitals adopt a single-disease fee-system to encourage hospitals to save costs in terms of benefits, shorter the number of hospital stays, and reduce the waste of medical resources.
Objective To analyze the influencing factors of hospitalization expenses of patients with primary liver cancer, and provide evidence for reducing the medical economic burden of patients. Methods In Nanning medical insurance for urban workers database, 209 discharge records diagnosed as primary liver cancer from January 2016 to June2017 were collected. The descriptive analysis and multiple linearity regression were used to analyze the structure and influencing factors of hospitalization expenses for patients with liver cancer. Results The proportion of various expenses in the total hospitalization expenses of liver cancer patients were 40.00% of medicine costs, 22.27% of materials costs,13.78% of inspection fees, 11.70% of laboratory expenses, and 11.10% of treatment expenses. The main influencing factors of hospitalization expenses were whether surgery, hospitalization days, age, gender, number of hospitalizations,and whether using critical illness insurance. Conclusion Hospitalization days, whether surgery, gender, age, number of hospitalizations, and whether or not to use critical illness insurance are factors influencing the total cost of hospitalization. In view of the heavier economic burden of liver cancer patients, it is recommended that the agencies of medical insurance for urban employees and hospitals adopt a single-disease fee-system to encourage hospitals to save costs in terms of benefits, shorter the number of hospital stays, and reduce the waste of medical resources.
引文
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[3]李秋林,余家华,容敏华,等.2013年广西肿瘤登记地区肝癌发病与死亡分析[J].中国癌症防治杂志,2017,9(6):462-468.
[4]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):434-441.
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[7]王明慧,曹乾,陆广春.城镇医保患者住院总费用及个人支付费用影响因素的通径分析[J].现代预防医学,2009,36(3):457-460.
[8]李蒙,黄鲜桃,黄志碧.广西肝恶性肿瘤患者住院费用的研究[J].医学与哲学(B),2014,35(2):92-94.
[9]肖静,高月霞,陆青云,等.6168例肝癌患者住院费用影响因素的通径分析[J].中国卫生经济,2012,31(1):73-75.
[10]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.
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[12]李蒙.2010-2013年广西原发性肝癌经济负担的研究[D].南宁:广西医科大学,2014.
[13]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.
[14]Kim YJ,Soeken KL.A meta-analysis of the effect of hospital-based case management on hospital length-ofstay and readmission[J].Nursing Research,2005,54(4):255-264.
[15]吕红亮,赵少峰,谢小萍,等.四川省16866例肺癌患者住院费用影响因素分析[J].中国循证医学杂志,2013,13(11):1283-1287.
[16]莫春梅,倪宗瓒,张琴.单病种费用影响因素的通径分析[J].中国医院统计,1999,6(4):213-215.
[17]杜春花.肝癌手术患者住院费用及其影响因素分析[J].河北医学,2008,14(10):1208-1211.
[18]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.
[19]许静,王伟,胡冰.安徽某地肝癌患者次均住院费用影响因素分析[J].肝胆外科杂志,2017,25(5):361-363.
[20]杨帆,于保荣.肝癌患者住院费用的变化及影响因素分析[J].卫生软科学,2012,26(5):488-490.
[2]邓伟,黄天壬,利基林,等.广西居民恶性肿瘤死亡流行特征及趋势分析[J].中国肿瘤,2013,22(6):423-427.
[3]李秋林,余家华,容敏华,等.2013年广西肿瘤登记地区肝癌发病与死亡分析[J].中国癌症防治杂志,2017,9(6):462-468.
[4]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):434-441.
[5]邵亚楠.单病种住院费用的多因素分析及模型选择[D].乌鲁木齐:新疆医科大学,2012.
[6]郭晓日,孟庆跃.20种疾病住院医疗费用因子分析[J].中国卫生经济,2010,29(7):82-84.
[7]王明慧,曹乾,陆广春.城镇医保患者住院总费用及个人支付费用影响因素的通径分析[J].现代预防医学,2009,36(3):457-460.
[8]李蒙,黄鲜桃,黄志碧.广西肝恶性肿瘤患者住院费用的研究[J].医学与哲学(B),2014,35(2):92-94.
[9]肖静,高月霞,陆青云,等.6168例肝癌患者住院费用影响因素的通径分析[J].中国卫生经济,2012,31(1):73-75.
[10]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.
[11]范琳琳.参保原发性肝癌患者住院费用结构及影响因素分析[D].天津:天津医科大学,2014.
[12]李蒙.2010-2013年广西原发性肝癌经济负担的研究[D].南宁:广西医科大学,2014.
[13]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.
[14]Kim YJ,Soeken KL.A meta-analysis of the effect of hospital-based case management on hospital length-ofstay and readmission[J].Nursing Research,2005,54(4):255-264.
[15]吕红亮,赵少峰,谢小萍,等.四川省16866例肺癌患者住院费用影响因素分析[J].中国循证医学杂志,2013,13(11):1283-1287.
[16]莫春梅,倪宗瓒,张琴.单病种费用影响因素的通径分析[J].中国医院统计,1999,6(4):213-215.
[17]杜春花.肝癌手术患者住院费用及其影响因素分析[J].河北医学,2008,14(10):1208-1211.
[18]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.
[19]许静,王伟,胡冰.安徽某地肝癌患者次均住院费用影响因素分析[J].肝胆外科杂志,2017,25(5):361-363.
[20]杨帆,于保荣.肝癌患者住院费用的变化及影响因素分析[J].卫生软科学,2012,26(5):488-490.